Prevention of gastrointestinal cancer by surveillance endoscopy

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.

Fig. 1

Superficial adenocarcinoma of stomach at angulus, staged T1,N0. At left, standard vision: a flat area with a reddened appearance. At right, indigocarmine chromoscopy: a 10 mm long depressed lesion, reddened in depth with clear borders; classified 0-IIc

Fig. 2

Advanced adenocarcinoma of stomach at angulus,Staged T3,N1. At left, standard vision: a flat reddened area surrounded by a swollen margin. At right, indigocarmine chromoscopy: a depression surrounded by multiple nodules, 15 mm in diameter. Not classified as a superficial lesion

Fig. 3

Hyperplastic sessile polyp in the colon. At left, standard vision: a sessile lesion with a small nodule at on extremity. At right, indigocarmine chromoscopy: the lesion is 10 mm in length, with a pit pattern type II with large openings; classified 0-IIa + Is

Fig. 4

Laterally spreading lesion (LST) in the colon with high grade intraepithelial neoplasia. At left, standard vision: a protruding nodule 6 mm in diameter surrounded by a slightly surelevated area with uncertain limits. At right, indigocarmine chromoscopy: the lesion is over 25 mm in length. Classified 0 IIa + Is and as a nodular mixed type of granular LST

Fig. 5

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