Invasion depth diagnosis of depressed type early colorectal cancers by combined use of videoendoscopy and chromoendoscopy

Third Department of Internal Medicine, Asahikawa Medical College, Asahikawa Kosei Hospital, Japan.
Gastrointestinal Endoscopy (Impact Factor: 5.37). 11/1998; 48(4):362-70. DOI: 10.1016/S0016-5107(98)70004-5
Source: PubMed


Depressed type early colorectal cancers are found less frequently than other polypoid cancers although they have a higher submucosal invasion rate. Recently videocolonoscopy and chromoendoscopy have become available and precise descriptions of these lesions are now routine. Because endoscopic mucosal resection is designated for intramucosal and focally extended submucosal (m-sm1) cancers, an evaluation of the characteristic findings indicating invasion depth with these modalities is important.
Between January 1991 and March 1996, 64 depressed type early colorectal cancers were detected and treated. When a faint abnormality of the mucosa was suspected by routine videocolonoscopy, 0.1% of indigo carmine solution was sprayed on the mucosal surface (chromoendoscopy). Colonoscopic findings of m-sm1 cancers and moderately and massively extended submucosal (sm2-3) cancers were retrospectively reviewed and compared with confirmed histologic findings.
Characteristic colonoscopic findings needed for surgical operation were as follows: (1) expansion appearance, (2) deep depression surface, (3) irregular bottom of depression surface, and (4) folds converging toward the tumor. By using these findings, the invasion depth of depressed type early colorectal cancers could be correctly determined in 58 of 64 lesions (91%).
Characteristic colonoscopic findings obtained by a combination of videocolonoscopy and chromoendoscopy are useful for determination of the invasion depth of depressed type colorectal cancers, an essential factor in choosing a treatment modality.

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    • "Non-polypoid flat or depressed polyps were excluded. Further, sessile polyps over 15 mm in size and pedunculated polyps over 20 mm in head size were excluded, as were polyps in which malignancy was confirmed by prior biopsy or suspected by gross morphology such as deep depression and a type V pit pattern during endoscopy [16] [17]. "
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