Early colorectal cancer: concept, diagnosis, and management

In colorectal cancers, although flat and depressed-type lesions are found by regular endoscopic view, magnification and pit-pattern observation are vital parts of the precise diagnosis of the lesion. The depressed-type lesions appear to have a prominent tendency to show malignant characteristics, and the recognition and timely treatment of such lesions is important for improving the morbidity and mortality of colorectal cancer. Chromoscopy is mandatory for an accurate diagnosis of these lesions. The pit-pattern classification correlates well with actual histological findings and can provide important additional information prior to endoscopic treatment of the lesion.

Endoscopic characteristics of colorectal serrated lesions

BACKGROUND/AIMS

With the recent changes of pathological concepts, colorectal serrated lesions can be now divided into traditional serrated adenoma, typical hyperplastic polyp and sessile serrated polyp. The aim of this study is to clarify the endoscopic differences among these three groups.

METHODOLOGY

A total number of 362 serrated lesions larger than 5mm were evaluated. These were detected with ordinary view and observed also with magnifying chromoendoscopic view. The final pathologic diagnosis of the resected specimens was made blinded.

RESULTS

There were significant differences between traditional serrated adenoma and sessile serrated polypconcerning location, configuration and color. In chromoendoscopy, most of sessile serrated polyps and typical hyperplastic polyps showed star-like pattern, in contrast with traditional serrated adenomas most of which had fernor pinecone-like pattern. The differential diagnosis between traditional sessile polyp and the other two was possible with high accuracy. On the other hand, endoscopic distinction between sessile serrated polyp and typical hyperplastic polyp was not easy, except that the location and size were significantly different.

CONCLUSIONS

We can endoscopically differentiate between traditional serrated adenoma and sessile serrated polyp or typical hyperplastic polyp, but it is difficult to differentiate between the latter two.

Endoscopic diagnosis of sessile serrated polyp: A systematic review

The aim of the present review was to clarify how we should detect and diagnose sessile serrated polyps (SSP) endoscopically. A systematic search was conducted of MEDLINE from January 2004 through March 2018. Nine findings: (i) proximal location; (ii) size >10 mm; (iii) irregular shape; (iv) indistinctive border; (v) cloud-like surface; (vi) mucus cap; (vii) rim of debris in white-light endoscopy; (viii) dilated vessels; and (ix) dilated crypts (pits) in image-enhanced endoscopy were considered to be candidate discriminators of SSP from hyperplastic polyps. Prospective studies in a general setting are warranted to validate the above-mentioned endoscopic features of SSP during real-time colonoscopy and to determine whether these features are useful for the differential diagnosis of SSP.