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Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.

-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

NPL showed high prevalence and higher aggressiveness than polypoid lesions, especially the depressed type.

Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.

RESUMO -Contexto -O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo -Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. INTRODUÇÃONos últimos anos, a magnificação de imagens com ou sem o emprego da cromoscopia, tem ganho grande importância como recurso propedêutico para endoscopia digestiva, em especial, da colonoscopia (6,9,11,16,19,20) . Maior precisão diagnóstica requer detecção de pequenas alterações estruturais ou de coloração (8) , que podem ser diagnosticadas por meio da colonoscopia de alta resolução aliada à magnificação de imagens. Esta tecnologia permite o aumento de uma porção da imagem e sua visualização com grande riqueza de detalhes, seja ela obtida óptica ou digitalmente. A imagem endoscópica depende dos comprimentos de onda da luz que são refletidos pelo tubo digestivo. O sistema FICE ® ("Fuji Intelligent Color Enhancement"), por meio de filtros específicos para diferentes combinações de comprimentos de onda entre o vermelho, o verde e o azul, converte imagens ópticas em imagens espectrais altamente contrastadas. Desta forma, o FICE ® se apresenta como verdadeiro método de cromoscopia virtual, dispensando o emprego de corantes, o que levaria a ganho de tempo, redução dos custos e maior praticidade durante a colonoscopia.Neste estudo, pretende-se comparar a precisão diagnóstica desta nova ferramenta com o método clássico de magnificação de imagens aliada à cromoscopia com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS

Objectives: Linked-color imaging (LCI) is a new image-enhancement option that emphasizes mucosal surface contrast, facilitating the differentiation between colorectal lesions and normal mucosa. This study aimed to evaluate the potential of LCI to increase the detection of colorectal adenomas in screening colonoscopies. Methods: A prospective randomized study was conducted using white-light imaging (WLI), blue-laser imaging (BLI)-bright and LCI. The outcome measures were adenoma detection rate (ADR), mean number of adenomas per patient, and withdrawal time. Lesion characteristics such as size, morphology, location, and histology were also evaluated. Results: A total of 205 patients were randomized, and 251 adenomas were detected. The overall ADR was 62%. The ADR was 52.9% for WLI, 62.1% for BLI-bright, and 71% for LCI, and was significantly higher in the LCI group than in the WLI group (P=0.04). No significant difference was observed between LCI and BLI-bright (P=0.28) or BLI-bright and WLI (P=0.30). The mean number of adenomas per patient was 1.01, 1.03, and 1.62 for WLI, BLI-bright, and LCI, respectively, with a significant difference (P=0.02). Withdrawal time did not differ among the groups. A total of 71 adenomas were detected by WLI, 68 by BLI-bright, and 112 by LCI. There was no difference in the size and morphology of the adenomas detected, nor in the diagnosis of sessile serrated adenomas/polyps. Conclusion: LCI significantly increased the detection of adenomas in screening colonoscopies.

Background Image-enhanced endoscopy enables real-time differential diagnosis of colorectal lesions through the observation of microvascular architecture. Purpose To evaluate the efficacy of using blue laser imaging (BLI) for capillary pattern analysis in the differential diagnosis of neoplastic and non-neoplastic lesions. Patients and methods This prospective study included 920 consecutive superficial lesions diagnosed in 457 patients. The capillary pattern was analysed using BLI-bright magnification on the basis of the Teixeira classification. Histopathology was used as the reference standard. Results The adenoma detection rate was 42.3%, with a mean of 0.95 adenomas per patient. Neoplastic lesions were predominant (70.3%), of which 33 (5.1%) had advanced histology. Neoplastic progression was significantly increased in patients aged at least 50 years, in lesions at least 10 mm and in lesions located in the right colon (P<0.01). BLI-based capillary pattern analysis showed 95.5% accuracy, 95.7% sensitivity, 95.2% specificity, 97.9% positive predictive value and 90.3% negative predictive value in the diagnosis of neoplastic lesions. For 672 diminutive lesions (≤5 mm), BLI-based capillary pattern analysis showed 95.7% accuracy, 96.6% sensitivity, 93.6% specificity, 97.2% positive predictive value and 92.2% negative predictive value. Analysing only lesions up to 5 mm in the rectum and sigmoid colon, the values were 95.2, 93.9, 96.5, 95.8 and 94.8%, respectively. Conclusion BLI associated with magnification yielded excellent results for the real-time predictive histological diagnosis of colorectal lesions.