| Theme | Management of large colorectal polyp --Indication and technique of endoscopic treatment | |
|---|---|---|
| Title | Management of colorectal tumors over 2cm in diameter, from a radiologic viewpoint | |
| Publish Date | 2000/11 | |
| Author | Hiroyuki Kobayashi | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Tadahiko Fuchigami | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Yuji Sakai | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Hideya Oda | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Youko Wada | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Tomohiko Moriyama | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Tatsunobu Hagimoto | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Yasuhiro Ohta | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Toshimi Iura | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Motonori Sato | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| Author | Kana Matsuura | Institute of Gastroenterology, Matsuyama Red Cross Hospital |
| [ Summary ] | Endoscopic or surgically resected colorectal tumors over 2cm in diameter were analyzed for their macroscopic apperance and histology (adenoma and carcinoma), and discussed from a radiologic viewpoint, concerning the diagnosis of their depth of infiltration and treatment, based on the analysis. In the types of protruded lesions (Isp, Is and I) and flat el evated lesion (IIa), basal deformities greater than semicircular in shape from the lateral view of the lesion as seen in barium enemas, were useful for the diagnosis of carcinomas, with a depth more than sm massive (sm2) infiltration. However, it was impossible to obtain a lateral view of all of them. It was also useful to analyze their en-face apperrance, including macroscopic and histological findings such as gross nodular surface, fold convergency, surface depression and biopsical diagnosis of carcinoma. On the other hand, nodule-aggregating lesions (NAL), were not as useful in terms of of basal deformities in the lateral view findings, excluding the gross nodular type and the en-face apperance without findings of surface depression. Therefore, with NAL, it was most important to detect surface depressions, which are only recognized more than sm massive carcinoma, in the en-face view from barium enemas. In cases of tumors over 3cm in diameter, which are concidered to be adenomas or carcinomas with a depth less than that for sm massive infiltration, we considered that minimally invasive colorectal resection such as laparoscopy-assisted colectomy, TEM and MITAS would be a better treatment than endoscopic mucosal resection, which had a higher incidence of remnants or recurrence in these larger tumors. |
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