28. Wash residue during insertion. When performing
a chromoendoscopy with targeted biopsy, irrigate the colon of debris with water while intubating to the cecum. Any remaining residue should be meticulously washed and suctioned before the application of chromoendoscopy. Chromoendoscopy begins once one reaches the cecum and the colonoscope is withdrawn. Performing chromoendoscopy when www.selleckchem.com/Akt.html the colon is dirty is very difficult: when the blue dye mixes with the bilious stool, it turns green. Figure options Download full-size image Download high-quality image (387 K) Download as PowerPoint slide Fig. 29. Target biopsies of abnormal or suspicious areas. Most dysplasia is visible and, thus, biopsies should be targeted. Rather than taking random biopsies, the endoscopist compares the color, pattern of the pits, glands, and, when visible, the microvessels to the background mucosa to target biopsies to abnormal-appearing areas. Figure options Download full-size image Download high-quality image (204 K) Download as PowerPoint slide Fig. 30. Evaluate lesions thoroughly. A biopsy forceps
was used to investigate part of the large, superficial, elevated lesion that lay behind the fold. The colon was slightly deflated as the forceps was used to expose the proximal side of the lesion. Figure options Download full-size image UK-371804 chemical structure Download high-quality image (484 K) Download as PowerPoint slide Fig. 31. An algorithm to detect, diagnose, and treat colorectal
neoplasms in patients with colitic IBD using chromoendoscopy and targeted biopsy. (From Soetikno R, Subramanian V, Kaltenbach T, et al. The detection of nonpolypoid (flat and depressed) colorectal neoplasms in patients with inflammatory bowel disease. Gastroenterology 2013;144(7):1349–52; with permission.) Figure options Download full-size image Download high-quality image (340 K) Download PtdIns(3,4)P2 as PowerPoint slide Fig. 32. Using high-definition instruments, image-enhanced endoscopy (IEE) is performed with indigo carmine using 3 different concentrations. Varying the concentration is important, depending on the indication. For example, if the solution is too concentrated when spraying the entire colon, it can make the colon dark and impair inspection. The corollary is when selectively spraying indigo carmine on a lesion for detailed inspection the solution is too weak, in which case it does not enhance visualization or contrast. When resecting a lesion, the authors perform submucosal injection using a dilution of indigo carmine and saline (10 drops of indigo carmine with 100 mL of normal saline). (From Soetikno R, Subramanian V, Kaltenbach T, et al. The detection of nonpolypoid (flat and depressed) colorectal neoplasms in patients with inflammatory bowel disease. Gastroenterology 2013;144(7):1349–52; with permission.) Figure options Download full-size image Download high-quality image (177 K) Download as PowerPoint slide Fig. 33.