Magnified Observation of Minute Changes of Polypoid Lesions in the Large Intestine M. Tada 1 , K. Kawai 1 , H. Niki 2 , T. Hattori 3 , S. Fujita 3 1Dept. of Preventive Medicine, Kyoto Prefectural University of Medicine 2Dept. of 3rd Internal Medicine, Kyoto Prefectural University of Medicine 3Dept. of 2nd Pathology, Kyoto Prefectural University of Medicine pp.625-636
Published Date 1978/5/25
DOI https://doi.org/10.11477/mf.1403107312
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 Recently, remarkable advance in fiberoptics and vigorous efforts to observe the whole colon has made it much easier to insert endoscope into the ileocecal area. It is no exaggeration to say that almost all lesions of the colon and terminal ileum can be diagnosed by endoscopy. One of our recent interests in colonoscopy is how to diagnose minute lesions correctly. For this purpose, several new methods have been attempted in our clinic. One of them is a dye spraying method and another is a close-up observation with the use of the magnifying colonoscope.

 Using the dye spraying method, the mucosal surface was seen as a fine network pattern, not observed by conventional colonoscopy. Small polypoid lesions could be easily differentiated by this method. For the second method, a newly devised magnifying colonoscope, type CF-MB-M (Olympus), was developed. The optical system of CF-MB-M is different from that of CF-MB, which is marketed. The forcusing system of CF-MB is fixed, whereas that of CF-MB-M is adjustable. Therefore, we can have not only the conventional view (distant view) but also the close-up view (magnified observation) by using the CF-MB-M. Its close-up observation enables us to magnify the mucosa about 10~25 times larger than the CF-MB.

 Minute structures of polypoid lesions were clearly observed through the combination of the CF-MB-M and methylene blue dye spraying method. Staining the lesions and magnifying them about 10~25 times larger, several types of structures of pits or sulcus, clearly similar to the observations by the dissecting microscope, were seen. These minute surface appearances were classified into six categories : circular, papillary, tubular, sulcus, mixed and irregular types. Most of metaplastic polyps were of circular and papillary types, adenomatous polyps were of tubular or sulcus and all of advanced cancer were of the irregular type. Therefore, differential diagnosis of these benign polyps and advanced cancer can always be diagnosed by this method. In our series, 67% of early cancers were of the irregular type, and were easily differentiated from benign polyps. But, 33% which were proved to have focal cancer revealed tubular or slucus types and showed the almost same appearance as the benign adenomatous polyps. Therefore, the diagnosis of early cancer or diminutive cancer still remains to be a problem and further improvements of both the magnifying capabilities of the scope and the dye spraying method will be necessary.

 Nevertheless, by magnifying the mucosa in familiar polyposis coli, we were able to observe several enlarged minute pits, strongly supposed as “the bud of adenoma”

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