Invasion depth diagnosis of depressed type early colorectal cancers by combined use of videoendoscopy and chromoendoscopy
ABSTRACT 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.
SourceAvailable from: Byong Duk Ye[Show abstract] [Hide abstract]
ABSTRACT: Abstract Goals. The purpose of this study is to investigate the learning curve for colonoscopic polypectomy (CP) by trainee endoscopists. Background. The amount of training required to achieve technical competence for CP is uncertain. Study. The CP times and en bloc resection rates of three experienced colonoscopists were obtained from 240 procedures. These data were compared to those of three gastroenterology trainees who performed 750 CP procedures. A trainee procedure was deemed to be a success if en bloc resection was obtained and the CP time was within twice the median CP time of the experienced colonoscopists. Trainees were deemed to be technically competent when they achieved a CP success rate of greater than or equal to 80%. Results. The median CP times and en bloc resection rates for the experienced colonoscopists and trainees were 79 s (range, 20-301 s) and 99.6% (239/240), and 118 s (range, 36-1051 s) and 95.6% (717/750), respectively. The trainee success rate of CP was 72% (540/750). The success rate of the procedure was associated with increased trainee experience (p = 0.003) and reached 80% after 250 procedures. The CP time significantly decreased (p < 0.001) and en bloc resection rate significantly increased (p = 0.011) as trainee experience accumulated. The level of experience was an independent predictor for successful CP. Conclusions. The achievement of technical competence with CP was associated with an accumulation of approximately 250 procedures. These findings suggest that dedicated education and training programs for CP are warranted.
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ABSTRACT: Endoscopic mucosal resection (EMR) of early gastric cancer, which has been proved to be safe and effective and is the established standard of care in Japan, has become increasingly established worldwide in the past decade. Endoscopic submucosal dissection (ESD) is superior to EMR, as it is designed to provide precise pathologic staging and long-term curative therapy based on an en bloc R0 specimen irrespective of the size and/or location of the tumor. However, ESD requires highly skilled and experienced endoscopists. The introduction of ESD to the Western world necessitates collaborations between Eastern and Western endoscopists, pathologists, and surgeons.Gastrointestinal endoscopy clinics of North America 04/2014; 24(2):213-233. DOI:10.1016/j.giec.2013.11.009
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ABSTRACT: La cromoendoscopia de magnificación es una nueva y atractiva herramienta que permite un análisis detallado de la arquitectura morfológica de los orificios de las criptas de la mucosa. En esta revisión describimos, principalmente, la eficacia de la cromoendoscopia de magnificación y de la colonoscopia de magnificación con NBI para el diagnóstico diferencial de las lesiones colorrectales, incluyendo una distinción entre lesiones neoplásicas y no-neoplásicas y también entre cáncer temprano tratable endoscópicamente o no, basados en una revisión de la literatura. Hemos conducido un estudio prospectivo mostrando que una combinación de la colonoscopia de magnificación y la cromoendoscopia es actualmente un método más confiable que la colonoscopia convencional y la cromoendoscopia para la distinción entre lesiones neoplásicas y no-neoplásicas del colon y del recto. La colonoscopia de magnificación con NBI es tan precisa como la cromoendoscopia de magnificación. Nosotros utilizamos colonoscopia de magnificación con NBI más que la cromoendoscopia para distinguir de rutina los pólipos neoplásicos de los no-neoplásicos. Los colonoscopistas pueden predecir la profundidad de la invasión del cáncer colorrectal por medio de la cromoendoscopia de magnificación, la colonoscopia de magnificación con NBI y a través del signo de no-levantamiento. Entre estos métodos, la cromoendocopia de magnificación es el más confiable, con una exactitud, sensibilidad y especificidad de 98,8%, 85,6% y 99,4%, respectivamente. Aunque su confiabilidad depende de la habilidad del que hace la observación, la difusión de las aplicaciones de la técnica de magnificación podría influir en las indicaciones de biopsias de muestreo durante la colonoscopia y en las de mucosectomía.Revista Colombiana de Gastroenterologia 03/2011; 26(1):43-57.