Colorectal carcinoma represents a major cause of mortality and 0.2–12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.

Background/Aim: The endoscopic diagnosis of preneoplastic lesions and early gastric cancer is based on subtle morphological changes, which are difficult to recognize during routine examinations. The study was performed in order to establish the role of autofluorescence imaging (AFI) and magnifying endoscopy with narrow band imaging (ME-NBI) for the diagnosis of premalignant gastric lesions. Methods: The study included patients with dyspeptic symptoms and/or known risk factors for gastric cancer. Imaging consisted of white light endoscopy (WLE), followed by AFI and ME-NBI. Targeted biopsies were taken from all the highlighted lesions, regardless of the method. A statistical analysis was performed to compare the results. Results: Sensitivity of AFI (94.74%) was superior to WLE and ME-NBI (78.95%). Specificity of AFI (65.33%) was however lower than the ME-NBI and WLE, with an accuracy of 71.27%. ME-NBI has high sensitivity, a much better specificity than AFI (92%) and a diagnostic accuracy of 89.36%. Trimodal endoscopy had an accuracy of 92.55%, which was superior to all other methods. Nevertheless, ME-NBI use had reduced the percentage of false positives from 27.65% to 6.38%, thus increasing specificity. Conclusion: Trimodal endoscopy could be proposed as a standard endoscopic technique, as it is quick, safe and accurate for the diagnosis and surveillance of premalignant and malignant upper gastrointestinal tract lesions.