Endoscopy 2020; 52(12): E432-E433
DOI: 10.1055/a-1158-8780
E-Videos

Acetic acid for subtle serrated lesions of the right colon: does it facilitate diagnosis?

Martin Miguel Galvarini Recabarren
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Lisandro Pereyra
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Cristian Ahumada
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Federico Bentolila
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Pablo Luna
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Daniel Cimmino
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
,
Luis Boerr
Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina
› Author Affiliations
 

Sessile serrated adenomas/polyps (SSA/Ps) have a well-established malignant potential. Because of their subtle appearance, they pose a special diagnostic challenge for the endoscopist [1] [2].

Improving SSA/P detection and characterization during routine colonoscopy is crucial to prevent right colon cancer [3]. Acetic acid is a fatty acid. When sprayed on a mucosal surface, it alters the structure of the glycoproteins and the nuclear and cytoplasmatic proteins of the cells [4]. This process changes the optical properties of these areas and results in acetowhitening. Positive acetowhitening could occur in SSA/Ps owing to their high number of goblet cells with high mucous content (glycoproteins).

We present three cases illustrating the usefulness of acetic acid in the detection and characterization of subtle right colonic lesions in patients undergoing screening colonoscopy using a standard definition scope (CF-Q150 L colonoscope; Olympus Medical, Tokyo, Japan).

In the first patient, the lesion was almost invisible, except for the presence of vessel amputation. Acetic acid instillation clearly showed a well-defined polyp ([Fig. 1 a, b]). In the two other patients, 0-IIa type subtle lesions with unclear, blurry limits were identified. Acetowhitening not only allowed better definition of the margins (and pit pattern), but in one case also revealed that an edematous-looking adjacent area was also part of the polyp ([Fig. 2 a, b], [Fig. 3]).

Zoom Image
Fig. 1 Colonic lesion area (inside white arrows) before and after acetic acid instillation. a Vessel amputation without visible polyp. b Clear polyp identification after acetowhitening.
Zoom Image
Fig. 2 Lesion before and after acetic acid instillation. a Subtle lesion without clear margins. b Clear margin delimitation after acetowhitening.
Zoom Image
Fig. 3 Pit pattern identification after acetic acid instillation.

Acetic acid chromoendoscopy is inexpensive and easy to perform. We highly recommend its use to help evaluate subtle serrated lesions and optimize their management.

Video 1 Usefulness of acetic acid chromoendoscopy in the detection and characterization of subtle right colonic lesions found during routine screening colonoscopy.


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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy: results of the complete adenoma resection study. Gastroenterology 2013; 144: 74-80
  • 2 IJspeert JE, de Wit K, van der Vlugt M. et al. Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists. Endoscopy 2016; 48: 74-76
  • 3 Pereyra L, Gomez EJ, Gonzalez R. et al. Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?. Dig Dis Sci 2014; 59: 3021-3026
  • 4 Chedgy FJ, Subramaniam S, Kandiah K. et al. Acetic acid chromo endoscopy: improving neoplasia detection in Barrett’s esophagus. World J Gastroenterol 2016; 22: 5753-5760

Corresponding author

Lisandro Pereyra, MD
Endoscopy Unit
Hospital Alemán
Av Pueyrredon 1640
Buenos Aires CABA 1118
Argentina   
Fax: +54-11-48277000   

Publication History

Article published online:
06 May 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy: results of the complete adenoma resection study. Gastroenterology 2013; 144: 74-80
  • 2 IJspeert JE, de Wit K, van der Vlugt M. et al. Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists. Endoscopy 2016; 48: 74-76
  • 3 Pereyra L, Gomez EJ, Gonzalez R. et al. Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?. Dig Dis Sci 2014; 59: 3021-3026
  • 4 Chedgy FJ, Subramaniam S, Kandiah K. et al. Acetic acid chromo endoscopy: improving neoplasia detection in Barrett’s esophagus. World J Gastroenterol 2016; 22: 5753-5760

Zoom Image
Fig. 1 Colonic lesion area (inside white arrows) before and after acetic acid instillation. a Vessel amputation without visible polyp. b Clear polyp identification after acetowhitening.
Zoom Image
Fig. 2 Lesion before and after acetic acid instillation. a Subtle lesion without clear margins. b Clear margin delimitation after acetowhitening.
Zoom Image
Fig. 3 Pit pattern identification after acetic acid instillation.