Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Nov;55(11):1592-7.
doi: 10.1136/gut.2005.087452. Epub 2006 May 8.

Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum

T Uraoka  1 , Y Saito, T Matsuda, H Ikehara, T Gotoda, D Saito, T Fujii
Affiliations

Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum

T Uraoka et al. Gut. 2006 Nov.

Abstract

Background: Laterally spreading tumours (LSTs) in the colorectum are usually removed by endoscopic mucosal resection (EMR) even when large in size. LSTs with deeper submucosal (sm) invasion, however, should not be treated by EMR because of the higher risk of lymph node metastasis.

Aims: To determine which endoscopic criteria, including high magnification pit pattern analysis, are associated with sm invasion in LSTs and clarify indications for EMR.

Methods: Eight endoscopic criteria from 511 colorectal LSTs (granular type (LST-G type); non-granular type (LST-NG type)) were evaluated retrospectively for association with sm invasion, and compared with histopathological findings.

Results: LST-NG type had a significantly higher frequency of sm invasion than LST-G type (14% v 7%; p<0.01). Presence of a large nodule in LST-G type was associated with higher sm invasion while pit pattern (invasive pattern), sclerous wall change, and larger tumour size were significantly associated with higher sm invasion in LST-NG type. In 19 LST-G type with sm invasion, sm penetration determined histopathologically occurred under the largest nodules (84%; 16/19) and depressed areas (16%; 3/19). Deepest sm penetration in 32 LST-NG type was either under depressed areas (72%; 23/32) or lymph follicular or multifocal sm invasion (28%; 1/32 and 8/32, respectively).

Conclusions: When considering the most suitable therapeutic strategy for LST-G type, we recommend endoscopic piecemeal resection with the area including the large nodule resected first. In contrast, LST-NG type should be removed en bloc because of the higher potential for malignancy and greater difficulty in diagnosing sm depth and extent of invasion compared with LST-G type.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

References

    1. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 199325455–461. - PubMed
    1. Saito Y, Fujii T, Kondo H.et al Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 200133682–686. - PubMed
    1. Tanaka S, Haruma K, Oka S.et al Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 20015462–66. - PubMed
    1. Tamura S, Nakajo K, Yokoyama Y.et al Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors. Endoscopy 200436306–312. - PubMed
    1. Hurlstone D P, Sanders D S, Cross S S.et al Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 2004531334–1339. - PMC - PubMed