| Theme |
Type V irregular pit in magnifying colonoscopy |
| Title |
Employing magnified chromoendoscopy to determine early colorectal cancer treatment, through pit pattern analysis |
| Author |
Hisashi Nakamura |
Department of Gastroenterology, Chofu Surgical Clinic |
| Author |
Akihiko Yamamura |
Department of Pathology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Yasuhiro Oono |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Yousuke Iriguchi |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Johji Oda |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Masaru Mizutani |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Tomoaki Shinohara |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Satoshi Takayanagi |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Yasuhiro Tomino |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Daisuke Kishi |
Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center |
| Author |
Jun Matsumoto |
Department of Surgery, Tokyo Metropolitan Fuchu Hospital |
| [ Summary ] |
Methods employing pit patterns for the analysis of early colorectal cancers, in order to provide appropriate treatment are described. First, the detected lesions should be given a careful general observation with a conventional view after washing. Subsequently, chromoendoscopy using indigo-carmine dye spraying is employed for observation of pit patterns. This method is a termed the contrast method, and it is useful to determine whether the detected lesions are neoplastic or non-neoplastic, especially for polypoid and flat elevated lesions which exhibit type IIIL and type IV pit patterns according to Kudo's classification. In contrast, it is necessary to use staining methods such as crystal violet staining, for lesions displaying type IIIs or type V pit patterns, since those pit patterns are difficult to observe or determine through chromoendoscopy, using indigo-carmine. It is especially important to use crystal violet staining to determine whether the detected lesions are submucosal deeply invasive cancers or not. During magnification after crystal violet staining, there should be careful observation of the demarcated area detected by indigo-carmine to decide whether it has an invasive pattern, which is suggestive of a submucosal deeply invasive cancer according to Fujii's classification. In our opinion, to improve the quality of pit pattern analysis, it is necessary to consistently compare pit patterns in vivo by chromoendoscopic magnification of ex vivo pit patterns through stereomicroscopy. In addition, the correlation of endoscopic findings and pathological details is also important. |