Purpose
The purpose of this video is to illustrate the use of high resolution anoscopy in the diagnosis and treatment of anal high-grade squamous intraepithelial lesions.
Methods
Five patients with anal dysplasia were examined in the operating room with acetic acid and the operative microscope. Lugol's solution was used selectively. Acetic acid is generously applied to aide in the recognition of high-grade squamous intraepithelial lesions. Acetowhite regions are examined under the operative microscope to further distinguish lesions as either low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions. Acetowhite lesions with specific vascular characteristics like punctuate vessels or honeycomb patterns are highly suggestive of high-grade disease. These lesions are selectively destroyed under direct visualization with an effort to maintain normal mucosa and skin to prevent stenosis. Some pigmented lesions contain high-grade squamous intraepithelial lesions; the operative microscope is used in this setting to look for the vascular characteristics of high-grade disease.
Results
The video reports five male patients treated for high-grade squamous intraepithelial lesions with the aide of high resolution anoscopy. There were no intraoperative or postoperative complications. All lesions suspicious for high-grade squamous intraepithelial lesions based on observed vascular patterns were confirmed as such with permanent histopathology.
Conclusion
The use of acetic acid and the operative microscope with selective use of Lugol's solution accentuates the visual characteristics of high-grade lesions, enhancing the surgeon's ability to target treatment to high-grade squamous intraepithelial lesions. High resolution anoscopy is useful in the targeted treatment of high-grade squamous intraepithelial lesions.
Article PDF
Similar content being viewed by others
Reference
GC Chang JM Berry N Jay JM Palefsky ML Welton (2002) ArticleTitleSurgical treatment of high-grade anal squamous intraepithelial lesions: a prospective study Dis Colon Rectum 45 453–458 Occurrence Handle12006924 Occurrence Handle10.1007/s10350-004-6219-8
Author information
Authors and Affiliations
Corresponding author
Additional information
This multimedia article (video) has been published online and is available for viewing at http://www.springerlink.com. Its abstract is presented here. As a subscriber to Diseases of the Colon & Rectum you have access to our SpringerLink electronic service, including Online First.
Reprints are not available.
About this article
Cite this article
Pineda, C.E., Berry, J.M. & Welton, M.L. High Resolution Anoscopy and Targeted Treatment of High-Grade Squamous Intraepithelial Lesions. Dis Colon Rectum 49, 126 (2006). https://doi.org/10.1007/s10350-005-0212-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-005-0212-8