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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
0013-726X
1438-8812
Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

10.1055/a-2387-4051
E-Videos-2024-06-5102-EV
E-Videos
Anal intraepithelial neoplasia screening during colonoscopy: a technical proposal
http://orcid.org/0000-0002-2625-9569
Igi Willian Ferreira MD
Nascimento Daiane Marrai Costa Dr.
Afonso Magda Priscila Cardoso Dr.
http://orcid.org/0000-0001-6189-5272
Mota Fernando Lander M.D.
Nova da Costa Lucas Santana Dr.
Brum Eloisa Barbosa Dr.
Rocha Fernanda Freitas Franca Dr.
1 Departamento de Gastroenterologia, CAEDRO – Centro Avançado de Endoscopia Digestiva de Rondônia, Porto Velho, Brazil
2 67766 Endoscopy Department, Hospital de Amor, Barretos, Brazil
3 42522 Endoscopy Unit, Hospital Sírio-Libanês, São Paulo, Brazil
4 Endoscopy Unit, Hospital Sírio-Libanês, Brasília, Brazil
5 Serviço de Coloproctologia, Hospital Barão de Lucena, Recife, Brazil
6 Gastroenterology Department, 6. Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil
Correspondence Willian Ferreira Igi, MD CAEDRO – Centro Avançado de Endoscopia Digestiva de RondôniaRua Julio de Castilho, 149, sala 03Centro, Porto Velho/RO, 76801-078Brazilwillianigi@hotmail.com
04 9 2024
12 2024
1 9 2024
56 Suppl 1 E762E763
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmc Current recommendations for anal cancer screening are limited to high risk populations, utilizing anal cytology, high risk human papillomavirus (HPV) testing, and high-risk HPV-cytology co-testing. Depending on the results, patients are then referred for further evaluation with high-resolution anoscopy (HRA), a resource that is scarce in most locations 1 . This procedure can identify anal intraepithelial neoplasias (AINs), precursor lesions of anal squamous cell carcinoma, allowing for early treatment 2 .

Magnifying or image-enhanced endoscopies provide superior magnification compared to HRA 2 , and a classification system for AIN has even been proposed 3 . However, blind anorectal intubation remains a common practice during colonoscopy 4 , missing the opportunity to diagnose AIN.

In this video, we demonstrate the inspection of the anal canal using narrow-band imaging (NBI) and near focus with an Evis EXERA III CV-190 processor, Evis EXERA III CLV-190 light source, and CF-HQ-190 colonoscope (Olympus Medical Systems, Tokyo, Japan). The goal is to detect AIN, with a special focus on identifying abnormal intrapapillary capillary loops ( Fig. 1 , Fig. 2 ). Given the short length of the anal canal, its inspection can be quickly performed before the colonoscopy ( Video 1 ). The proximity of the canal walls makes the use of near focus or magnification highly advantageous, allowing for the detection of lesions that are often underdiagnosed.

Fig. 1 Low grade dysplastic lesion of the anal canal detected via colonoscopy with narrow-band imaging (NBI) and near focus.

Fig. 2 High grade dysplastic lesion of the anal canal with dilated, tortuous, and meandering intrapapillary capillary loops assessed using a disposable anoscope and NBI and near focus.

Anal evaluation during colonoscopy with the aim of identifying anal intraepithelial neoplasia.

Video 1

Although there are limitations in the evaluation of the anal canal, the squamocolumnar junction can still be reasonably observed through insufflation or retroflexion 2 . After identifying the suspicious lesion, we chose to complement the examination with a disposable anoscope to achieve better visualization and stabilization for performing biopsies.

In this way, we consider that anal canal evaluation should be performed during all colonoscopies using NBI and near focus/magnification, aiming to identify AIN.

Endoscopy_UCTN_Code_TTT_1AQ_2AI

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Acknowledgement

We would like to thank Dr. Andreia Albuquerque from Fernando Pessoa Teaching Hospital, Portugal, for her assistance in improving our management of anal intraepithelial neoplasia cases.

Conflict of Interest The authors declare that they have no conflict of interest.
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References

1 Stier EA Clarke MA Deshmukh AA International Anal Neoplasia Societyʼs consensus guidelines for anal cancer screening Int J Cancer 2024 154 1694 1702 10.1002/ijc.34850 38297406
2 Sakamoto T Akiyama S Narasaka T Anal intraepithelial neoplasia: Precursor of anal squamous cell carcinoma J Anus Rectum Colon 2022 6 92 99 10.23922/jarc.2021-077 35572484
3 Pecere S Hassan C La Milia D Accuracy of narrow-band imaging in predicting the histology of anal intraepithelial lesions Eur J Gastroenterol Hepatol 2023 35 31 35 10.1097/MEG.0000000000002457 36468566
4 Martínez-Alcalá A Manovski K Mönkemüller K Direct anorectal intubation during colonoscopy: a logical new paradigm Endoscopy 2023 55 E488 E489 10.1055/a-2025-0284 36858351
