Nonpolypoid neoplastic lesions of the colorectal mucosa

Kudo, Shin Ei; Lambert, René; Allen, John I.; Fujii, Hiroaki; Fujii, Takeshi; Kashida, Hiroshi; Matsuda, Takahisa; Mori, Masaki; Saitō, Hiroshi; Shimoda, Tadakazu; Tanaka, Shinji; Watanabe, Hidenobu; Sung, Joseph J.Y.; Feld, Andrew D.; Inadomi, John M.; O’Brien, Michael; Lieberman, David A.; Ransohoff, David F.; Soetikno, Roy; Triadafilopoulos, George; Zauber, Ann G.; Teixeira, Cláudio Rolim; Rey, Jean François; Jaramillo, Edgar; Rubio, Carlos A.; Gossum, A. Van; Jung, Michael; Vieth, Michael; Jass, Jeremy R.; Hurlstone, Paul

doi:10.1016/j.gie.2008.07.052

Cited by 474 publications

(443 citation statements)

References 137 publications

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“…Thus, increasing emphasis on maximizing adenoma detection could result in a broader range of lesions removed, including many with a more subtle and flat morphology than was detectable in early studies. Contrary to some suggestions, flat morphology without depression is not associated with an increased risk of advanced pathology and may be associated with a lower risk of advanced pathology [16][17][18] .…”

Section: Introductioncontrasting

confidence: 92%

“…Further the fraction of polyps ≤ 5 mm and 6-9 mm in size was comparable to or higher than prior studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][22][23][24][25][26][27][28][29] . Any underestimation of polyp size would tend to cause the apparent prevalence of cancer in polyps of different size ranges to increase.…”

supporting

confidence: 78%

“…As noted earlier, the trends toward decreasing prevalence rates of cancer in small and diminutive polyps may reflect the improved imaging capabilities of colonoscopes, and increasing emphasis on identification of flat lesions which do not increase the risk of cancer compared to polypoid lesions [16][17][18] .…”

mentioning

confidence: 92%

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Risk of cancer in small and diminutive colorectal polyps

Ponugoti

Cummings

Rex

2017

Digestive and Liver Disease

117

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The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps < 10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements)Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps < 10 mm in size. A total of 4,790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There were 23,524 conventional adenomas < 10 mm of which 22,952 were tubular adenomas.There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤ 5 mm in size and 0.8% of adenomas 6-9 mm in size. Of all conventional adenomas, 2.1% of those ≤ 5 mm in size and 5.6% of those 6-9 mm in size were advanced. Among 36,107 polyps ≤ 5 mm in size and 6,523 polyps 6-9 mm in size, there were no cancers.These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.

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Section: Introductioncontrasting

confidence: 92%

supporting

confidence: 78%

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Risk of cancer in small and diminutive colorectal polyps

Ponugoti

Cummings

Rex

2017

Digestive and Liver Disease

117

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“…Although the designation intramucosal carcinoma is currently discouraged by the WHO, it has recently been included in the pragmatic classification of superficial neoplastic colorectal lesions [3,4]. In conclusion, we report the first case of an intramucosal colorectal mucinous adenocarcinoma, which was successfully removed endoscopically.…”

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confidence: 76%

Early mucinous colorectal adenocarcinoma – mucosal type

et al. 2010

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“…The frequency of lymph node metastases is proportional to the degree of depth being 2, 8, and 23 %, respectively [6]. The Paris classification [3], revised in Kyoto in 2008 [7], defines every lesion extended no more than 1 mm in the submucosal layer as 'sm1'. Forty percent of CRCs are located in the rectum.…”

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confidence: 99%

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment

et al. 2013

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Background Management of malignant rectal polyps (MRPs) after endoscopic polypectomy (EP) is still debated. It is sometimes difficult to decide whether to simply follow-up (FU) or to treat such a removed lesion. Transanal endoscopic microsurgery (TEM) could have a role both in T staging and in treating MRPs after EP. Methods Patients who underwent a full-thickness TEM within 3 months after an EP between January 2008 and October 2012 were retrospectively analyzed. If post-TEM histology showed locally advanced rectal cancer, patients underwent a total mesorectal excision (TME) within 4-6 weeks. Patients without malignant disease or pT1sm1 cancers at post-TEM histology were followed up every 3 months for 2 years with clinical examination, flexible rectal endoscopy, and neoplastic markers monitoring. Results A total of 39 patients were included. Post-EP histology was adenocarcinoma in 27/39 cases (69.2 %) and adenoma in 12/39. Mean operative time was 64.2 min; no 30-day mortality occurred; 30-day morbidity was 2.7 % (rectal bleeding in 1/39 cases). Post-TEM histology showed a T2 cancer in 5/39 patients, four with and one without a previous cancer diagnosis, who were further treated by TME (four RARs and one APR) and are disease free with a mean FU of 24.2 months. Post-TEM histology showed adenoma in 10/39 cases and fibrosis in 24/39. These patients are disease free with a mean FU of 13 months. Conclusions A full-thickness TEM after EP of MRPs can establish the presence of residual malignant disease and its depth of invasion, precisely defining the indication to TME. In event of benign post-EP histology, TEM must be performed in presence of macroscopic residual disease, in order to obtain an RO resection and finally exclude cancer, while, in absence of macroscopic residual disease, only close FU is required. Keywords Rectal polyps Endoscopic mucosal resection Transanal endoscopic microsurgery Total mesorectal excision Colorectal cancer (CRC) represents the most frequently diagnosed neoplasm in Europe (436,000 new cases/year, i.e. 13.6 % of diagnosed tumors) [1] and accounts for 8 % of deaths for neoplasm in the world and 12.2 % in Europe [2]. With

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Nonpolypoid neoplastic lesions of the colorectal mucosa

Cited by 474 publications

References 137 publications

Risk of cancer in small and diminutive colorectal polyps

Risk of cancer in small and diminutive colorectal polyps

Early mucinous colorectal adenocarcinoma – mucosal type

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment

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