Case 14.4
The patient underwent surveillance colonoscopy. The endoscopist performed examination using high definition white light with random biopsy throughout the colon.
Submission to pathology showed that one of the 33 biopsy samples had sessile serrated lesion vs serrated epithelial change. It was in the jar labeled right colon at 70cm.
A GI pathologist confirmed this sample as a sessile serrated lesion vs serrated epithelial change.
What should the endoscopist's next step be?
Schedule a surveillance colonoscopy to use narrow banding imaging (NBI) in 6 months.
Refer the patient to an experienced endoscopist with chromoendoscopy expertise for a surveillance colonoscopy.
The first step in evaluation of patients with flat or invisible lesions prior to consideration of colectomy should be a colonoscopy performed under chromoendoscopy
Refer the patient to a surgeon for hemicolectomy due to a high risk of colorectal cancer.
Schedule a surveillance colonoscopy to use high-definition colonoscopy with white light rather than standard-definition colonoscopy with white light.
In considering the patient’s surveillance colonoscopy planning, what would have been the optimal surveillance method for detection of dysplasia in this high risk patient?
CT colonography
High resolution white light colonoscopy with random biopsy
High definition white light colonoscopy with targeted biopsy
Virtual or Dye Chromoendoscopy with targeted biopsy