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Session:: ePosters-Sun350-M4: Other Neoplasia and Endoscopy

EP650 - Catching More: Can AIN Screening Be Done At The Time Of Colonoscopy

Sunday, May 10, 2026
3:55 PM - 4:00 PM ET

    ePoster Presenter(s)

  • Koby Herman, MD

    Fellow
    Henry Ford Providence Hospital
    Henry Ford Providence Hospital
    Ferndale, MI, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Saleh Busbait

    Colorectal Surgery Fellow
    Henry Ford Providence Hospital
    Southfield, MI, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

  • Surya Nalamati, Md, FACS,FASCRS

    Program Director
    Henry Ford Hospital
    Novi, Michigan, United States

    Disclosure information not submitted.

  • ED

    Ernesto R. Drelichman, MD

    President Elect Medical Staff
    Henry Ford Health
    rochester hills, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jasneet S. Bhullar, MD, MS, FACS, FASCRS.

    Clinical Associate Professor of Surgery MSU/CHM, Program Director Colorectal Surgery Fellowship MSU
    Henry Ford Health
    Henry Ford- MSU Colorectal Surgery Fellowship, MI
    Rochester Hills, Michigan, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: Proper anal SCC screening hinges on early detection of premalignant anal intraepithelial neoplasms (AIN), particularly for high risk patients. This involves assessing magnified views of the squamocolumnar junction of the anus, most commonly performed with HRA. Colonoscopy and the use of narrow-band imaging offers a chance at high-magnified assessment of this area and subsequent therapeutic intervention, but formal guidelines or recommendations are lacking.

Methods/Interventions: A review of the available literature regarding the use of colonoscopy for anal SCC screening and AIN detection was performed, including PUBMED, MEDLINE and Cochrane Databases.

Results/Outcomes: There is a scarcity of retrospective/prospective studies - the majority of published literature represents individual case reports. A single prospective study from a tertiary care center in the US reported 25 cases of AIN discovered between 2011-2018. A study from Australia found AIN in 1 of 253 adult patients receiving colonoscopy (1 of 157 for women > 40 years old). Strategies described across case series internationally include the use of a magnified NBI, a transparent hood, and/or lugol chromoendoscopy.

Conclusion/Discussion: Anal SCC is often diagnosed at an advanced stage - better screening is essential. Routine rectal retroflexion and magnified NBI assessment of the anal canal/anal transition zone is not performed, however this may provide an important opportunity to broaden and strengthen screening efforts. Magnified NBI assessment of the anal transition zone should be performed at the time of any screening colonoscopy, with appropriate biopsies obtained. Guidelines for classifying mucosal irregularities of the anus should be codified, similar to existing classifications for the esophagus.

Current Literature on AIN Screening During Colonoscopy
1. James S. Wu. Anal dysplasia detection during routine screening colonoscopy. Surg Case Rep Rev. 2018. DOI: 10.15761/SCRR.1000120

2. Forbes CM, McCloskey J, Forbes GM. Opportunistic detection of anal intraepithelial neoplasia at colonoscopy. JGH Open. 2020 Oct 14;4(6):1207-1210. doi: 10.1002/jgh3.12424. PMID: 33319057

3. Pecere S, Hassan C, La Milia D, et al. Accuracy of narrow-band imaging in predicting the histology of anal intraepithelial lesions. Eur J Gastroenterol Hepatol. 2023 Jan 1;35(1):31-35. doi: 10.1097/MEG.0000000000002457

4. Oono Y, Fu K, Nakamura H, et al. Narrowband imaging colonoscopy with a transparent hood for diagnosis of a squamous cell carcinoma in situ in the anal canal. Endoscopy. 2010;42 Suppl 2:E183-4. doi: 10.1055/s-0029-1244038.

5. Ito T, Morita S, Shimeno N, et al. The prospect of endoscopic submucosal dissection for early anal canal squamous cell carcinoma. Clin J Gastroenterol. 2016 Dec;9(6):384-388. doi: 10.1007/s12328-016-0690-3

6. Wagner A, Neureiter D, Holzinger J, et al. Endoscopic submucosal dissection (ESD) for anal high-grade intraepithelial neoplasia: a case report. Z Gastroenterol. 2018 May;56(5):495-498. English. doi: 10.1055/a-0578-9059

7. Voss JK, Kurdi AT, Neto MB, et al. Detection of Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma on Colonoscopy. ACG Case Rep J. 2022 Jun 22;9(6):e00792. doi: 10.14309/crj.0000000000000792

8. Dang H, Verhoeven DA, Basiliya K, et al. Endoscopic intermuscular dissection of early anal cancer. Endoscopy. 2024 Dec;56(S 01):E472-E473. doi: 10.1055/a-2321-9527