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DETECTING ANAL INTEREPITHELIAL NEOPLASM DURING ROUTINE COLONOSCOPY — CAN IT BE TRANSLATED TO ROUTINE PRACTICE. SINGLE INSTITUTION EXPERIENCE
maryam aleissa
*, Molly F. Synowicz, Ernesto Drelichman, Jasneet S. Bhullar
Department of Surgery, Ascension Providence Hospital Southfield Campus, Southfield, MI
BackgroundHuman papillomavirus HPV is a major risk factor for anal squamous cell cancers ASCC, with anal intraepithelial neoplasia as a precursor lesion. The detection of AIN in the setting of routine colonoscopy is not well described despite the potential for early identification of ASCC. This study aims to assess the rate of AIN detection during routine colonoscopy and its clinical significance.
Methods/Interventions
This is a retrospective study performed at a single community-based hospital in Michigan, USA. A consecutive series of 2,000 colonoscopies carried out between January 2021 and December 2023 were retrospectively reviewed. All patients underwent screening colonoscopies wherein the anorectum and transition zones were inspected for AIN lesions with a narrow band imaging, during retroflextion . Biopsies were carried out when suspected abnormalities were found, after which the specimens were studied by gastrointestinal pathologists. All patients with confirmed AIN were referred to high resolution anoscopy HRA with treatment.
ResultsOf the 2,000 patients, 53% were female and 47% male. AIN was identified in 1% of the patients (n = 19) at the time of retroflextion. The median age of AIN patients was 49 years, with 56% males. Of note, 69% (n = 11) were immunocompetent. Of these patients who were referred to HRA, 36% (n = 7) pathology reviled high-grade AIN.
Discussion:This study demonstrated that the AIN detection rate was low; however, it may provide significant dividends for the detection of AIN during routine practice . Early detection is important particularly for high-grade lesions, given the potential for progressions to ASCC. These findings raise awareness among endoscopists, particularly in high-risk populations, and point to a need for assessment of the immunocompetent patient undergoing routine colonoscopy. Considering the concerns over biopsy-related complications, none were observed, hence justifying its safety.
Conclusion:Routine colonoscopy with retroflexion using a narrow band imaging offers a good opportunity for AIN detection, even in immunocompetent patients. The possibility of detection of AIN may lead to ASSC prevention. It worth incorporating AIN screening during routine colonoscopy into daily practice as well as in teaching fellows and residents to how identifying these lesions.
Endoscopy image showing anal interepithelial neoplasia lesionA, flat or slightly raised areas of thickened anal mucosa. B, irregular blood vessel mosaic appearance at anal mucosa during retroflection using narrow-band imaging light.
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