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Prevention of gastrointestinal cancer by surveillance endoscopy.

Lambert R - EPMA J (2010)

Bottom Line: The classification of the endoscopic appearance of superficial neoplastic lesions of the digestive mucosa aims to evaluate the risk of progression to advanced neoplasia in 3° (low, intermediate, high) and to predict appropriate treatment and corresponding surveillance.The privileged position of endoscopy results from its double impact on prevention of digestive cancer through reduction in incidence after early detection and eradication of precursors; and through reduction of mortality after detection and treatment of cancer at an early and curable stage.However the efficacy of diagnostic endoscopy still requires improvement and quality control on the following points: (1) technology, with a generalized use of the recently introduced high-resolution endoscopes. (2) diagnosis of poorly visible nonpolypoid precursors: this applies to small depressed lesions and large slightly elevated or sessile serrated and non-serrated precursors, particularly in the proximal colon. (3) treatment and training in therapeutic endoscopy, including the most recent techniques of mucosal resection of nonpolypoid lesions.

View Article: PubMed Central - PubMed

Affiliation: I.A.R.C., Lyon, France.

ABSTRACT
The classification of the endoscopic appearance of superficial neoplastic lesions of the digestive mucosa aims to evaluate the risk of progression to advanced neoplasia in 3° (low, intermediate, high) and to predict appropriate treatment and corresponding surveillance. The privileged position of endoscopy results from its double impact on prevention of digestive cancer through reduction in incidence after early detection and eradication of precursors; and through reduction of mortality after detection and treatment of cancer at an early and curable stage. However the efficacy of diagnostic endoscopy still requires improvement and quality control on the following points: (1) technology, with a generalized use of the recently introduced high-resolution endoscopes. (2) diagnosis of poorly visible nonpolypoid precursors: this applies to small depressed lesions and large slightly elevated or sessile serrated and non-serrated precursors, particularly in the proximal colon. (3) treatment and training in therapeutic endoscopy, including the most recent techniques of mucosal resection of nonpolypoid lesions.

No MeSH data available.


Related in: MedlinePlus

Laterally spreading lesion (LST) in the colon with high grade intraepithelial neoplasia. At left, standard vision: a sessile lesion 20 mm in diameter with sharp limits and a central depression. At right, indigocarmine chromoscopy and magnification: epithelial crests show a villous pattern. Classified as 0-IIa and as a nodular type of granular LST
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Fig5: Laterally spreading lesion (LST) in the colon with high grade intraepithelial neoplasia. At left, standard vision: a sessile lesion 20 mm in diameter with sharp limits and a central depression. At right, indigocarmine chromoscopy and magnification: epithelial crests show a villous pattern. Classified as 0-IIa and as a nodular type of granular LST

Mentions: Characterization classifies the lesion prior to pathology, in introduction to treatment decision based on the evaluation of the risk of malignancy in lesions with a neoplastic appearance [3–34]. Therefore the rules of the analysis are the same for premalignant precursors and for superficial cancer. The histopathology prediction is based at first on gross morphology (Figures 1, 2, 3, 4 and 5): in non depressed lesions (type 0-I, IIa, IIb) the risk of invasive malignancy increases with the size. In depressed lesions (type 0-IIc) the risk occurs even if they are small and less than 6 mm in diameter. Then the surface microarchitecture is analyzed with magnification, combined with dye chromo-endoscopy and the network of superficial capillaries is analyzed in transparency. The NBI technique has recently confirmed its efficacy in this analysis.Fig. 1


Prevention of gastrointestinal cancer by surveillance endoscopy.

Lambert R - EPMA J (2010)

Laterally spreading lesion (LST) in the colon with high grade intraepithelial neoplasia. At left, standard vision: a sessile lesion 20 mm in diameter with sharp limits and a central depression. At right, indigocarmine chromoscopy and magnification: epithelial crests show a villous pattern. Classified as 0-IIa and as a nodular type of granular LST
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3405338&req=5

Fig5: Laterally spreading lesion (LST) in the colon with high grade intraepithelial neoplasia. At left, standard vision: a sessile lesion 20 mm in diameter with sharp limits and a central depression. At right, indigocarmine chromoscopy and magnification: epithelial crests show a villous pattern. Classified as 0-IIa and as a nodular type of granular LST
Mentions: Characterization classifies the lesion prior to pathology, in introduction to treatment decision based on the evaluation of the risk of malignancy in lesions with a neoplastic appearance [3–34]. Therefore the rules of the analysis are the same for premalignant precursors and for superficial cancer. The histopathology prediction is based at first on gross morphology (Figures 1, 2, 3, 4 and 5): in non depressed lesions (type 0-I, IIa, IIb) the risk of invasive malignancy increases with the size. In depressed lesions (type 0-IIc) the risk occurs even if they are small and less than 6 mm in diameter. Then the surface microarchitecture is analyzed with magnification, combined with dye chromo-endoscopy and the network of superficial capillaries is analyzed in transparency. The NBI technique has recently confirmed its efficacy in this analysis.Fig. 1

Bottom Line: The classification of the endoscopic appearance of superficial neoplastic lesions of the digestive mucosa aims to evaluate the risk of progression to advanced neoplasia in 3° (low, intermediate, high) and to predict appropriate treatment and corresponding surveillance.The privileged position of endoscopy results from its double impact on prevention of digestive cancer through reduction in incidence after early detection and eradication of precursors; and through reduction of mortality after detection and treatment of cancer at an early and curable stage.However the efficacy of diagnostic endoscopy still requires improvement and quality control on the following points: (1) technology, with a generalized use of the recently introduced high-resolution endoscopes. (2) diagnosis of poorly visible nonpolypoid precursors: this applies to small depressed lesions and large slightly elevated or sessile serrated and non-serrated precursors, particularly in the proximal colon. (3) treatment and training in therapeutic endoscopy, including the most recent techniques of mucosal resection of nonpolypoid lesions.

View Article: PubMed Central - PubMed

Affiliation: I.A.R.C., Lyon, France.

ABSTRACT
The classification of the endoscopic appearance of superficial neoplastic lesions of the digestive mucosa aims to evaluate the risk of progression to advanced neoplasia in 3° (low, intermediate, high) and to predict appropriate treatment and corresponding surveillance. The privileged position of endoscopy results from its double impact on prevention of digestive cancer through reduction in incidence after early detection and eradication of precursors; and through reduction of mortality after detection and treatment of cancer at an early and curable stage. However the efficacy of diagnostic endoscopy still requires improvement and quality control on the following points: (1) technology, with a generalized use of the recently introduced high-resolution endoscopes. (2) diagnosis of poorly visible nonpolypoid precursors: this applies to small depressed lesions and large slightly elevated or sessile serrated and non-serrated precursors, particularly in the proximal colon. (3) treatment and training in therapeutic endoscopy, including the most recent techniques of mucosal resection of nonpolypoid lesions.

No MeSH data available.


Related in: MedlinePlus