ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand) | February 2026-Detecting Flat Colorectal Neoplasms

Video Transcription

Video Summary

The transcript is a teaching discussion on how to detect subtle, flat colorectal lesions during colonoscopy. Participants suggest looking for pit pattern changes, bumps, and mucosal pattern differences, but the faculty emphasize a different expert mindset: experts primarily “look for normal,” and detect lesions by noticing disruptions from normal anatomy rather than searching for “a polyp.”<br /><br />Using cognitive task analysis, they describe key normal features to continuously scan for: homogeneous color, consistent surface/crypt pattern, intact vessel pattern, and especially uninterrupted “innominate grooves/lines” that connect crypts. Flat neoplasia is suspected when these patterns are interrupted—e.g., lines that suddenly stop, fold contour that widens or deforms, focal redness/whiteout, loss of grooves, mucus caps, or surface vessel obliteration. Once a disruption is seen, experts quickly define lesion borders by comparing with surrounding normal mucosa, then move to classification (e.g., nonpolypoid neoplasm vs sessile serrated features).<br /><br />They discuss imaging: white light is commonly used for detection; NBI and newer electronic chromoendoscopy (e.g., LCI) are often applied after detection to characterize histology, though newer data suggest NBI can aid detection with excellent prep.<br /><br />Finally, they note routine use of distal attachment devices (caps or Endocuff) to improve mucosal exposure and fold manipulation, with practical cautions about cap placement, reduced field of view, and navigation in tight sigmoid turns.

Asset Subtitle

Roy Soetikno

Keywords

flat colorectal lesions

colonoscopy detection

normal mucosa disruption

innominate grooves interruption

pit and crypt pattern changes

NBI and electronic chromoendoscopy (LCI)

distal attachment devices (cap, Endocuff)