| Theme | Can we change to treat for diminutive colorectal polyp ? | |
|---|---|---|
| Title | Management of diminutive colon polyps using endocytoscopy | |
| Publish Date | 2014/05 | |
| Author | Shin-ei Kudo | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Yuichi Mori | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Kunihiko Wakamura | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Katsuro Ichimasa | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Masashi Misawa | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Toyoki Kudo | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Yoshiki Wada | Digestive Disease Center, Showa University Northern Yokohama Hospital / Division of Endoscopy, Tokyo Medical and Dental University |
| Author | Hideyuki Miyachi | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Haruhiro Inoue | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| [ Summary ] | Recent advances in endoscopic imaging modalities allow precise real-time predictions of polyp histology in the colorectum. With this advance, the "Resect and Discard" strategy for management of diminutive colorectal polyps was proposed by a number of western researchers. This strategy necessitates an accurate endoscopic diagnosis in advance of treatment. Attention must also be paid to the benefit of significantly decreasing pathology-associated time, as well as costs. Endocytoscopy, which enables observation at 450-fold magnification levels during gastrointestinal endoscopy allowing on-site "optical biopsy", may become an efficient tool for this treatment strategy. Endocytoscopy can be employed to precisely discriminate diminutive adenomas from diminutive non-neoplastic polyps with sensitivity of 94 %, specificity of 93 %, and accuracy of 94 %. However, the "Resect and Discard" strategy possibly presents some risks of misdiagnosing advanced neoplasms (which were 3 % of diminutive colorectal polyps in our facility) and discarding them without pathological assessment. Therefore, very careful evaluation is necessary for validation of this strategy both domestically and internationally. | |