Initially clues was abnormalities inside mucosal appearances such as ‘pinkness, moment depressions and you may/or haemorrhagic spots’ 49

The fresh colonoscope technology NBI and you will FICE create comparable features

• Viewpoints are supplied while the letter/full n (%). Paris endoscopic classification regarding superficial colorectal neoplasms, relating submucosal intrusion so you can polyp morphology and size. This desk, redrawn away from Kudo’s distribution toward Paris Working area 2003, forty-five shows brand new proportion (amounts and you will percentages) out of attack into the submucosa, with reference to the big macroscopic kinds in this Sorts of 0 and to your diameter of the lesion (during the four groups). Analysis was indeed obtained from a keen endoscopy series having cystic confirmation (19 560 lesions at that time ) at a negative balance Get across Medical during the Akita and you will Showa Northern Healthcare when you look at the Yokohama.

Classical protuberant lesions (0-Ip and 0-Is) are common, and size influences invasive risk: lesions of 5 mm or less are associated with negligible risk, but for lesions over 20 mm the risk of malignancy is high. Recognition of depression (type 0-IIc) in colorectal lesions is critical as this is often associated with invasive cancer, even when the lesion is small (< 10 mm). These true depressed lesions are rare but grow rapidly, become advanced at an early stage of the evolution of their growth and are seldom suitable for endoscopic resection. Because they are subtle, dye spray chromoendoscopy with indigocarmine is invaluable to demarcate them from background innominate grooves and delineates the surface, edge and any areas of depression. Saitoh et al. 48 combined chromoendoscopy with indigocarmine plus magnification of the area – a refinement not widely available in the UK. Polyps with more submucosal invasion – sm2 and sm3 – tended to have an expansive look, deeper depression with irregularity of the depressed surface and two or more converging folds. Such descriptions are subtle and, whilst in expert hands are highly predictive of invasion (91% sensitivity), they are difficult to translate into standard practice.

For a time there was doubt that flat polyps occurred in western populations because they were not being reported. It is now clear they do occur and are being detected. The Leeds group analysed a series of 1000 consecutive colonoscopies and found 321 adenomas 49 . Amongst these were a substantial number of flat polyps and a small number of true depressed lesions with significant malignant potential. Table 5 is redrawn from their data and shows, in a snapshot from a single (tertiary) centre, that not only do flat and depressed polyps exist but also that they can be detected in a UK population, and it highlights the small, but appreciable, risk of early cancer in polyps < 1 cm in diameter, as well as the greater risk with flat lesions of more than 1 cm in diameter. Depressed lesions are rare but frequently invasive. Suzuki et al. 50 reported data from St Mark's Hospital in London where 10% of cancers found by colonoscopy were of flat configuration and small (only 8–15 mm in diameter). The English Bowel Cancer Screening Programme requires all polyps to be classified by an endoscopist using the Paris system.

Web site, proportions and you may polyp morphology all of the dictate review off cancer malignancy from inside the a lesion. The Paris Category is actually detailed and you can predictive (Level III).

Endoscopists is lumen dating dating to estimate sized polyps and employ new Paris Class to have the ideal anticipate off malignancy (Top Good).

Epidermis pit pattern endoscopic prognosis off colorectal polyps

Detailed evaluation of the skin regarding polyps can also be subsequent assume histology. Chromoendoscopy using indigocarmine, plus magnifier colonoscopy can be identify apartment or depressed sores and you may identify the newest pit development regarding polyps you to predict fundamental cystic. Brand new Kudo Classification out of pit designs are shown diagrammatically inside Figs. dos 49, 51 .