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SSL is difficult to detect because of its flat morphology and the resemblance of its color to the surrounding normal mucosa. In clinical practice, delineation of recurrent SSLs can sometimes be challenging because of coexisting scar tissue.
Recently, a new endoscopy system called Eluxeo (Fujifilm Co, Tokyo, Japan) has been developed. The system provides 3 observation modes by generating variable light-emitting diode (LED) light intensity, including blue-light imaging (BLI). BLI consists of short wavelength absorption of hemoglobin (410 nm) combined with white-light spectral colors. BLI can be activated by pressing a button on the endoscope.
To our knowledge, the use of acetic acid for recurrent SSLs has not been presented before now. We hereby describe the first experience of acetic acid and Eluxeo in a case of recurrent SSL (Video 1, available online at www.VideoGIE.org).
Colonoscopy with a magnifying function and BLI (EC-760ZP-VM; Fujifilm Co) was used. The acetic acid (5%) was diluted in lukewarm water to derive a solution with a concentration of 1.7%. The solution was sprayed directly through the working channel of the endoscope onto the suggestive lesions without the use of a spray catheter. In 10 to 15 seconds, the aceto-whitening reaction began. Thereafter the polyps were assessed with white-light imaging (WLI) and BLI and were characterized before removal of the endoscope.
An 80-year-old man with a history of 2 polypectomies was referred to us. We performed follow-up colonoscopy 3 years after the last procedure. In the cecum, a polypoid lesion with a diameter of 8 mm was found on a scarred surface where the previous polypectomy was performed. The margin of the lesion was unclear (Figs. 1 and 2). We performed chromoendoscopy using acetic acid (Figs. 3 and 4). With magnification, the surface structure and the delineation became clearer, and the polyp was assessed as a recurrent SSL. It was resected en bloc by EMR (Fig. 5). The use of acetic acid in a concentration <2% was safe, and no adverse events were recorded.
Acetic acid induces a temporary chemical change to the surface called aceto-whitening reaction. The difference in the reaction helps to differentiate between normal and neoplastic mucosa.
The optical absorption property of the epithelial cells can be altered by acetic acid, and for that reason, BLI may potentially reveal white areas as more whitish than does WLI, which can contribute to better delineation of the lesion by BLI and acetic acid compared with WLI and acetic acid. Because it is not cumbersome to switch to BLI, the use of acetic acid in combination with BLI could be an excellent method to improve the visualization of recurrent SSLs and thereby increase the possibility of performing complete endoscopic resections.
All authors disclosed no financial relationships relevant to this publication.