靛胭脂染色内镜检查对大肠微小腺瘤和息肉的诊断价值

目的探讨靛胭脂染色内镜检查在诊断大肠微小腺瘤和息肉中的价值。方法将31个大肠微小息肉分别行普通内镜及靛胭脂染色内镜检杏的结果与组织学检查结果比较,并比较2种内镜检查方法对大肠微小腺瘤和息肉的诊断准确率。结果靛胭脂染色内镜对大肠微小腺瘤和息肉的诊断准确率显著高于普通内镜,D组与A组、C组比较差异有娃著性（55．2％vs12％、10％）,P〈0．05;D组与B组比较差异无显著性i55．2％（腺瘤13．8％）VS50％（腺瘤10％）],P〉0．05。结论靛胭脂染色内镜检查可提高大肠微小腺瘤和息肉的诊断准确率。     

大肠小的扁平腺瘤内镜和病理学研究

为着重研究大肠小的扁平瘤和非腺瘤性的早癌，本组１４６例大肠小的扁平隆起病变经病理活检进行内镜下形态和组织学对照研究。结果证实粘膜慢性炎１９例，炎性息肉６３例，增生性息肉３４例，小的扁平腺瘤２７例不含腺瘤成份的早癌３例。     

大肠息肉表面结构与病理组织学的关系研究

目的：探讨大肠息肉表面结构形态与病理组织学的关系，以提高对大肠息肉的实时诊断及治疗水平。方法：对105例大肠息肉进行靛胭脂染色，放大内镜观察其表面结构形态，并参照Kudo法进行分类：I、Ⅱ型为非瘤性息肉，ⅢL、ⅢS、Ⅳ及混合型为腺瘤性息肉，V型为癌变，比较息肉表面结构与大体形态及病理之间的关系。结果：17例有蒂息肉中12例表现为I、Ⅱ型；40例亚蒂息肉和48例广基息肉中I、Ⅱ型分别为15．0％（6／40）和41．7％（20／48），ⅢL、ⅢS、Ⅳ、Ⅴ、混合型合计为85．0％（34／40）和58．3％（28／48）。83．8％（88例）的息肉位于直肠至脾曲结肠，息肉表型与其发生部位无关。炎性及增生性息肉中非瘤性表型为78．6％，瘤性表型为21．4％；腺瘤息肉中非瘤性表型为3．3％，瘤性表型为96．7％；幼年性息肉均为非瘤性表型。I、Ⅱ、ⅢL、ⅢS、Ⅳ、Ⅴ及混合型息肉中腺瘤发生率分别为0％、11．8％、77．3％、75．0％、100．0％、100．0％和70．0％。分型诊断瘤性和非瘤性息肉的敏感性为96．7％和80．0％，特异性为86．6％和94．7％，鉴别诊断准确率为89．5％。结论：用染色放大内镜分析大肠息肉表面结构，能有效鉴别大肠非瘤性息肉、腺瘤和癌，有助于在结肠镜检查的同时决定对病灶的处理。     

智能染色内镜对早期大肠癌及其癌前病变的诊断价值

目的评价富士能智能电子分光技术（FICE）结合放大内镜在早期大肠癌诊断中的价值。方法2010年1月至2011年12月经普通内镜发现存在大肠黏膜可疑病灶且符合研究要求的患者共325例,行FICE结合放大内镜及靛胭脂染色检查,部分病变结合放大内镜及实体显微镜观察腺管开口分型（pit分型）并与病理诊断对照,pit分型采用工藤分型。结果396个病变中非肿瘤性病变占13．6％（544396）;各类腺瘤占76．0％（301／396）,其中3例腺瘤恶变,占腺瘤的1．0％（3／301）;进展期肠癌41例,占10．4％（41／301）。上述病变黏膜腺管开口类型分析显示在非肿瘤性病变中尤其增生性病变、炎性息肉绝大部分为Ⅰ、Ⅱ型腺管开口,占92．7％（38／41）。在肿瘤性病变中,管状腺瘤及管状绒毛腺瘤之腺管开口以Ⅲ。型为主,而绒毛状腺瘤则以Ⅳ型为多见。在进展期癌中,无1例外地表现为腺管开口的破坏。甚至无腺管结构。将FICE结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：FICE结合放大内镜诊断早期大肠癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为97．8％（361D96）、92．6％（38／41）、99．4％（353／355）、92．6％（38／41）、99．4％（353／355）：靛胭脂染色诊断早期大肠癌的诊断符合率、敏感性、特异性分别为97．7％（390／396）、87．8％（36／41）、98．9％（351／355）、1．12％（4／355）、12．3％（5／41）;二者比较差异均无统计学意义（P均〉0．05）。结论FICE结合放大内镜可以提供清晰的大肠黏膜血管图像,有助于早期大肠癌的诊断．可提高活检检查的准确性．与靛胭脂染色联用可提高早期大肠癌的诊断率。     

窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例,行NBI结合放大内镜及靛胭脂染色检查,对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检,将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）;靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40）,假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）;二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别,但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像,有助于早期胃癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期胃癌的诊断率。     

大肠平坦型腺瘤与隆起型腺瘤的临床特征比较

目的 探讨大肠平坦型腺瘤的发病情况,比较平坦型腺瘤与隆起型腺瘤的临床特征和镜下特点。方法设定一个时间段选择我院连续行结肠镜检查的患者,经肠镜下切除的并经病理证实为腺瘤的所有病变,收集完整的一般临床资料,根据镜下肉眼形态分为平坦型腺瘤和隆起型腺瘤,计算平坦型腺瘤在结肠镜检查人群中的检出率,应用构成比计算平坦型腺瘤占检出腺瘤的比例,比较平坦型腺瘤和隆起型腺瘤的临床特征和镜下特点,包括患者性别、年龄、病变大小和部位。结果结肠镜检查共10319例,符合纳入标准的共468例患者,550枚息肉,其中检出30例31枚息肉为平坦型腺瘤,438例519枚息肉为隆起型腺瘤,平坦型腺瘤在结肠镜检查人群中的检出率为0．29％,占检出腺瘤的6．41％;平坦型腺瘤和隆起型腺瘤的性别、年龄、大小和单发腺瘤／多发腺瘤的比率差异均无显著性;平坦型腺瘤有41．94％位于右半结肠,而隆起型腺瘤仅24．47％,差异有盟著性。结论平坦型腺瘤在国内并非罕见,平坦型腺瘤较隆起型腺瘤倾向发生于右半结肠,提示全大肠镜检查更有利于检出平坦型腺瘤。     

智能染色内镜对早期胃癌的诊断价值探讨

目的探讨富士能智能染色内镜（FICE）在早期胃癌中的诊断价值。方法2010年2月至2011年3月经普通胃镜检查后疑似早期胃癌的患者67例,分别行电子放大内镜、FICE染色放大内镜、靛胭脂染色放大内镜检查。对疑似病灶的胃黏膜腺管及微血管形态的清晰程度进行评分比较,并对疑似部位进行靶向活检,比较3种内镜诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率。结果67例患者中,经病理组织学检查诊断为早期胃癌17例。FICE染色放大内镜与电子放大内镜、靛胭脂染色放大内镜在观察腺管结构显示方面差异无统计学意义（P〉0．05）。在观察微血管形态方面,FICE染色放大内镜明显好于电子放大内镜、靛胭脂染色放大内镜（P〈0．05）。在诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率方面,FICE染色放大内镜分别为94．1％（16／17）、98．0％（49／50）、97．0％（65／67）,靛胭脂染色放大内镜分别为88．2％（15／17）、96．0％（48／50）、94．0％（63／67）,电子放大内镜分别为58．8％（10／17）、84．0％（42／50）、77．6％（52／67）,FIEC染色放大内镜均明显高于电子放大内镜（P〈0．05）,且均与靛胭脂染色放大内镜相近（P〉0．05）。结论FICE染色放大内镜可以更方便地提供清晰的血管图像,有助于早期胃癌的诊断,提高活检检查的准确率。     

内镜下黏膜染色联合黏膜切除对大肠侧向发育肿瘤的诊断治疗

目的 探讨普通电子肠镜下靛胭脂黏膜染色联合黏膜切除对大肠侧向发育型肿瘤及早期大肠癌的临床诊治价值。方法 对3860例肠镜检查中发现的肠腔黏膜隆起、红斑、表面粗糙不平、血管纹理消失、肠黏膜无名沟中断等可疑黏膜病灶，行镜下喷洒0．4％靛胭脂黏膜染色，对染色发现的大肠侧向发育型肿瘤，观察病灶大小并进行形态分型，病灶黏膜可随充吸气变形者及黏膜下注射液体呈抬举征阳性者行内镜黏膜切除（EMR）21例、内镜下分片黏膜切除术（EPMR）11例、未能行黏膜切除者行活检6例，切除病灶黏膜送病理检查。结果 发现LST病灶38侧，检出率为0．98％。其中．颗粒均一型18个（46．6％）、结节混合型10个（25．9％）、平坦隆起型7个（18．1％）．假凹陷型3个（7．8％）。病变分布：直肠15个（39．5％），乙状结肠8个（21．0％），降结肠5个（13．2％），横结肠4个（10．5％），升结肠3个（7．9％）．回盲部3个（7．9％）。病理检查：38例LST病灶中早期癌5例，检出率为13．2％，进展期大肠癌2例（5．2％）．良性腺瘤31（81．6％）。结论 普通电子肠镜下对大肠黏膜可疑病灶靛胭脂染色能够有效发现大肠LST病灶，联合镜下黏膜切除对早期大肠癌诊断和防治具有较高的临床价值。     

色素放大结肠镜诊断结直肠隆起性病变的临床应用

目的 探讨色素放大结直肠镜结合Kudo分型在诊断结直肠病变中的临床应用价值。方法 对125例病人行常规内镜诊断后，对结直肠新生儿进行染色并结合Kudo分型作出色素放大内镜诊断，取标本作病理检查，将仙和色素放大内镜诊断结果与病理诊断结果相比较，观察符合率。结果 在125例病灶中，普通内镜下诊断为炎性息肉，管状腺瘤，绒毛状腺瘤和结直肠癌的病理符合率分别为：95．6％，80．0％，90．0％和100％，总病理符合率为85．6％；色素放大内镜诊断的病理经分别为100．0％，93．8％，99％和100．0％，总病理经为95．2％。结论 色素放大结肠镜对判断结直肠病变的性质有较高的病理符合率，并能有效提高微小，表浅隆起型病灶的检出率，具有较高临床应用价值。     

大肠扁平腺瘤与息肉样腺瘤的对比研究

大肠扁平腺瘤指平坦或轻微隆起于大肠黏膜表面的腺瘤，其腺瘤成分的厚度不超过周围正常黏膜的两倍，1985年由Muto等最早报道。多项研究显示，大肠扁平腺瘤占所有大肠腺瘤患者的12％～42％，伴重度异型增生的比例超过12％，远高于息肉样腺瘤的4％，故认为扁平腺瘤是易癌变的特殊腺瘤类型。本研究通过结肠镜检查、病理检查和免疫组化染色研究大肠扁平腺瘤的特点。     

Clinicopathological features of nonpolypoid colorectal tumors as viewed from the patients' background

Background This study was performed to characterize the clinicopathological features of colorectal tumors with flat-, depressed-, or protruded-type morphology (hereafter referred to simply as flat, depressed, or protruded lesions). Methods There are two major types of colorectal tumor: polypoid (protruded) and nonpolypoid (flat and depressed). A total of 130 lesions from 130 patients with colorectal submucosal invasive cancer were classified into three groups according to their macromorphology seen during endoscopy: flat (laterally spreading) and depressed nonpolypoid tumors and protruded polypoid tumors. The following factors in the patients' background were evaluated: indication for colonoscopy, age, and family history of colorectal cancer in first-degree relatives (i.e., parents, siblings, children). We also compared the following characteristics of the tumors: size, location, depth of submucosal invasion, vascular invasion, and frequency of synchronous and metachronous tumor lesions. Results The incidence of abnormal findings on follow-up studies after polypectomy as an indication for colonoscopy was significantly higher among patients with flat lesions (4/24, 16.7%) and depressed lesions (3/22, 13.6%) than among those with protruded lesions (1/84, 1.2%) (P < 0.01, P < 0.01). Patients with flat lesions (65.8 ± 7.6 years old) were significantly older than those with protruded lesions (P < 0.05). The patients with flat tumors had a significantly higher rate of a family history of colorectal cancer (6/24, 25.0%) than patients with protruded or depressed lesions (P < 0.01, P < 0.05). The protruded lesions were significantly larger than the depressed lesions (size 13.3 ± 6.7 mm) (P < 0.05), and the flat lesions (24.1 ± 10.1 mm) were significantly larger than either the protruded or depressed lesions (P < 0.01, P < 0.01). Seventy-five percent (18/24) of the flat lesions were located in the right colon, and this proportion was significantly higher than that among the protruded or depressed lesions (P < 0.01, P < 0.01). The mean ± SD depth of submucosal invasion was 1218 ± 1034 μm in the flat lesions, 2392 ± 1869 μm in the depressed lesions, and 2761 ± 1929 μm in the protruded lesions, representing a significant difference (P < 0.05, P < 0.0001). Of the 24 patients with flat lesions, 9 (37.5%) showed vascular invasion; this proportion was significantly lower than that among patients with the depressed or protruded lesions (P < 0.01, P < 0.01). Patients with depressed lesions tended to have higher incidence of synchronous and metachronous malignant polyps than those with protruded or flat lesions. Conclusion It is important to examine the morphology of colorectal tumors when diagnosing them and planning the treatment strategy, including follow-up, after resection of nonpolypoid tumors. It is useful to know the patient's family history so nonpolypoid tumors can be accurately diagnosed.     

18-Fluorodeoxyglucose positron emission tomography has limited sensitivity for colonic adenoma and early stage colon cancer

BACKGROUND: 18-Fluorodeoxyglucose positron emission tomography (PET) is used clinically to detect recurrent colon cancer after surgical resection, but the sensitivity of PET for premalignant colon lesions and early stage colon cancer is not well defined. METHODS: In a prospective study, 45 patients with a total of 58 colonic neoplasms, including premalignant polyps, premalignant, flat lesions, and early stage cancers, were evaluated by PET. RESULTS: The sensitivity of PET for cancer was 62% (8/13). PET detected 100% (7/7) of cancers 2 cm or larger but only 17% (1/6) of cancers smaller than 2 cm. PET detected 23% (3/13) of flat, premalignant lesions; 70% (7/10) of protruded, premalignant lesions 3 cm or larger; 38% (3/8) of protruded, premalignant lesions between 2 and 2.9 cm; and 14% (2/14) of protruded, premalignant lesions between 1 and 1.9 cm. There was no false-positive PET reading. CONCLUSIONS: PET has limited sensitivity for flat, premalignant lesions; protruded, premalignant lesions smaller than 3 cm; and colon cancers smaller than 2 cm.     

Endoscopic findings of gastric neoplasms in familial adenomatous polyposis are associated with the phenotypic variations and grades of dysplasia

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric neoplasms. However, endoscopic findings have not been sufficiently investigated. We investigated the phenotypic expression of gastric adenoma (low-grade dysplasia) and gastric cancer (high-grade dysplasia or carcinoma) in patients with FAP and clarified their relationships to endoscopic findings. Of 29 patients with FAP who underwent esophagogastroduodenoscopy between 2005 and 2020, 11 (38%) had histologically confirmed gastric neoplasms, including 23 lesions of gastric adenoma and 9 lesions of gastric cancer. The gastric neoplasms were classified into 3 phenotypes (gastric, mixed, or intestinal type) according to the immunostaining results and evaluated for location (U or M region: upper or middle third of the stomach or L region: lower third of the stomach), color (same as the background mucosa, whitish, or reddish), macroscopic type (elevated, flat, or depressed), background mucosal atrophy (present or absent), fundic gland polyps in the surrounding mucosa (present or absent), and morphologic changes in tumor size. Elevated whitish gastric adenomas were further subdivided by macroscopic type (flat elevated, protruded, or elevated with a central depression) and color (milky- or pinkish-white). The gastric adenomas included gastric (11/23, 48%), mixed (4/23, 17%), and intestinal (8/23, 35%) phenotypes. In contrast, no lesions of gastric cancers showed a gastric phenotype (0/9, 0%), while 5 (56%) and 4 (44%) lesions were intestinal and mixed phenotypes, respectively. Gastric cancers were significantly more likely than gastric adenomas to present as reddish depressed lesions with gastric atrophy. All gastric-type adenomas occurred in non-atrophic mucosa, in mucosa with fundic gland polyps in the periphery, in the U or M region, and as flat elevated or protruded lesions with a milky-white color. Half of the lesions increased in size. Meanwhile, the typical endoscopic features of intestinal-type adenomas included occurrence in the L region and elevated pinkish-white lesions with central depression. None of the intestinal-type adenomas increased in size during the observation period. We believe that these endoscopic features will be useful for the prompt diagnosis and appropriate management of gastric neoplasms in patients with FAP.     

Clinicopathological Study on Flat and Depressed Minute Colorecta Carcinomas

Abstract: Over the last two years, a total colonoscopy was performed on 3,006 patients and 232 colorectal carcinomas were detected in these patients. Seventy one (30.6%) of the carcinomas were found to be early cancers. Eighteen (25.4%) of these 71 early cancers were minute (>5 mm) colorectal carcinomas of the flat or depressed type and they were resected endoscopically. More than half of them were accompanied by colonic polyps. Among the characteristic endoscopic features of flat and depressed early colorectal carcinomas are redness, fine granularity and defects of the innominate groove on the lesional surface. Another important finding is whitish annular mucosa surrounding the lesion. The gross appearance of these lesions was depression (3 lesions), depression with a marginal elevation (11 lesions), or flat (4 lesions). On histological examination, all the lesions were found to be well–differentiated intramucosal adenocarcinoma. It appears that depressed lesions with or without marginal elevation have a tendency to horizontal and vertical invasion, respectively. Moreover, it is thought that flat lesions are very early cancers that might later develop into depressed lesions with or without marginal elevation, or flat elevated lesions.     

Endoscopic Detection Rate of Minute Neoplasms in Autopsied Colons

Abstract: This study was designed to determine the actual incidence, distribution and morphology of minute neoplastic polyps, under 5 mm in diameter, in the so-called normal colon obtained at autopsy. In order to increase the sensitivity of detection of minute lesions, this study was done with the aid of electronic endoscopy using the dye spraying method. The case-occurrence of minute neoplastic polyps among the 49 autopsy cases was almost 50% and the ratio of cases without adenomas or cancers of the colon was no more than 50%. The ratio of minute neoplastic polyps among the total number of neoplastic polyps, based on electronic endoscopy, was much higher than that of minute polyps of autopsy cases reported previously with macroscopic observation. Regarding the grade of atypia of the minute neoplastic polyps, only one polyp (5 mm in diameter) among 85 lesions was a carcinoma. The results of this study indicate the possibility of considerable numbers of minute neoplastic polyps which are likely to go undetected by endoscopy, probably due to technical difficulties in endoscopic control and the lack of sufficient examination time for each patient.     

p53 overexpression in flat serrated adenomas and flat tubular adenomas of the colorectal mucosa

The expression of the p53 protein was investigated in flat serrated neoplasias as well as in other histological phenotypes of flat or exophytic hyperplasias or neoplasias of the colorectal, mucosa. A total of 104 such lesions were analyzed: 24 were flat serrated neoplasias (22 flat serrated adenomas and 2 flat serrated adenocarcinomas), 26 flat tubular adenomas, 17 flat hyperplastic polyps, 29 exophytic tubular and/or villous neoplasias (23 adenomas and 6 exophytic adenocarcinomas) and the remaining 8, exophytic hyperplastic polyps. Deparaffinized, rehydrated sections were treated immunohistochemically to detect those overexpressing the p53 protein. Lesions having slight (+), moderate (++) or intense (+++) staining were considered immunoreactive. The results showed that 50% of the flat serrated adenomas with low-grade dysplasia (LGD) and 66.7% of those with high-grade dysplasia (HGD) had p53 immunoreactivity. None of the flat tubular or of the exophytic adenomas with LGD expressed p53, but immunoreactivity was present in 61.5% of the flat tubular adenomas with HGD and in 52.3% of the exophytic adenomas with HGD. All adenocarcinomas had an intense p53 reaction. Weak p53 expression was demonstrated by 11.7% of the flat hyperplastic polyps but none of the exophytic polyps reacted. The occurrence of p53 expression in flat serrated adenomas with LGD suggested that, despite its low histological profile, one-half of those lesions could be biologically already committed to independent growth. The occurrence of p53 expression in nearly 12% of the flat hyperplastic polyps was totally unexpected and deserves further investigation. Flat serrated adenoma emerges as a novel, independent histological entity among the various phenotypes of flat neoplasias of the colorectal mucosa.     

Detection of colorectal polyps by multislice CT colonography with ultra-low-dose technique: comparison with high-resolution videocolonoscopy

BACKGROUND: This prospective study compared multislice CT colonography with ultra-low-dose technique to high-resolution videocolonoscopy as the standard for detection of colorectal cancer and polyps. METHODS: After standard bowel preparation, 115 patients underwent multislice CT colonography with an ultra-low-dose multislice CT colonography protocol immediately before videocolonoscopy. After noise reduction by using a mathematical algorithm, ultra-low-dose multislice CT colonographic images were analyzed in blinded fashion, and the results were compared with the results of high-resolution videocolonoscopy. RESULTS: A total of 150 lesions were detected by high-resolution videocolonoscopy in 115 patients. For ultra-low-dose multislice CT colonography, sensitivities for detection of polyps less than 5 mm in size, 5 to 10 mm, and greater than 10 mm in diameter were 76%, 91%, and 100%, respectively. Although the sensitivity for detection of flat lesions was only 50%, the sensitivity and the specificity for detection of polyps 5 mm or greater in size were 94% and 84%, respectively. For adenomatous lesions greater than 5 mm in size, sensitivity was 94% and specificity was 92%. The overall specificity was 79%. The calculated effective radiation dose ranged between 0.75 and 1.25 mSv. CONCLUSIONS: Compared with high-resolution videocolonoscopy, ultra-low-dose multislice CT colonography has excellent sensitivity and specificity for detection of colorectal lesions 5 mm or greater in size, and the radiation exposure is relatively low. However, before this technique can be generally recommended for colorectal screening, further improvement in the detection of flat and extremely small lesions must be achieved.     

Minute non-polypoid adenoma of the colon detected by colonoscopy: correlation between endoscopic and histologic findings

To characterize the endoscopic features of minute non-polypoid neoplastic lesions of the colon, we investigated the endoscopic, macroscopic, and histologic findings in 34 lesions detected by colonoscopy, which were smaller than 5 mm and were endoscopically recognized as flat or depressed lesions. The lesions were divided into two groups according to their endoscopic features; 8 lesions were completely flat and the remaining 26 lesions were flat-topped elevations with a central depression. Macroscopic examinations revealed that the center of the endoscopically flat lesion was slightly elevated, whereas the center of the flat-topped elevation was characterized by a central depression. All of the lesions were histologically diagnosed as tubular adenomas. The flat lesions were composed of flatly elevated adenomatous glands, while the flat-topped elevations with a depression were characterized by surrounding hyperplasia arising from normal glands. The whole thickness of the mucosa was replaced by adenomatous glands in the lesions with an obvious central depression, while the adenomas tended to spread superficially in the lesions with a shallow depression. These findings suggest that pre-cancerous lesions other than small polyps do exist in the colon and that colonoscopic examination provides some clue toward a prediction of the histologic architecture of the lesions.     

Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

OBJECTIVE: Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps >or=20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. MATERIAL AND METHODS: A retrospective analysis was conducted on the outcome of 161 polyps >or=20 mm in diameter, treated by piecemeal EMR at a single centre using the "lift and cut" technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. RESULTS: Over an 8-year period, 161 colonic polyps measuring >or=20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). CONCLUSIONS: With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps >or=20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.     

Morphological factors aid in therapeutic decisions concerning gastric adenomas.

The morphology of 73 gastric adenomas and 134 protruded early gastric carcinomas was studied. Most adenomas were less than 2 cm in diameter (76.7%), while protruded lesions larger than 2 cm were more frequently early cancers (P less than 0.01). Adenomas larger than 4 cm in diameter usually contained foci of adenocarcinoma (83.3%). Flat or depressed adenomas were rare (6.8%). Protruded adenomas were compared with protruded early cancers. The superficial elevated adenoma was common, and the combined superficial elevated and superficial depressed form (IIa + IIc) was frequent in early cancer (P less than 0.001). A smooth surface was more common in adenoma (P less than 0.05), and erosion or ulcer more frequent in early cancer (P less than 0.01). Pale color was more common in adenoma (P less than 0.001), while areas of red were more frequent in early cancer (P less than 0.001). Gastric adenomas more than 2 cm, especially those more than 4 cm, in diameter, with flat or depressed or IIa + IIc morphology, with surface erosion or ulcer, and/or areas of red are likely to contain to cancer and should be treated aggressively.