Hurlstone, D.P.; Shorthouse, A.J.; Adam, I.; Brown, S.; Cross, S.S.; Korulla, C.; Davies, R.; Lobo, A.J.I.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA23
Academic Journal
Introduction: EMR in parallel with high resolution chromoscopic colonoscopy (HRCC) may permit safer and more accurate resection practice. Residual tumour or a disrupted, incomplete resection interface can be difficult to detect with conventional endoscopic techniques. Aim:To evaluate the efficacy of HRCC in predicting complete horizontal and vertical resection margins for flat lesions less than 10 mm diameter. Subjects and Methods: Total colonoscopy was performed on 600 consecutive patients using the Olympus CF240Z endoscope from 01/02 to 09/02 by a single endoscopist. 196 lesions were evaluated using HRCC pre- and post-EMR, using locally applied 0.5% indigo carmine (lC). The crypt appearance of all lesions was graded according to the modified Kudo class. Those demonstrable of a type V(n) or V(a)/llls were excluded due to the high risk of submucosal-massive invasion, and lesions failing to "lift" symmetrically at EMR. Lesions with a Kudo I crypt exclusively were additionally excluded (hyperplastic). Resection was performed en-block with submucosal lift using 0.5% lC and an Olympus barbed snare. Resection margins were then reassessed with a second dye spray around the circumferential horizontal and vertical border. Type I/II crypt was used as evidence of complete resection endoscopically. Histological confirmation was obtained on all specimens. Results: See Table. Percentage agreement between HRCC and actual histological verification of vertical and horizontal clearance was calculated using the Kappa statistic, κ = 0.78 (excellent agreement, 95% CIs). Conclusion: Prospect ve evaluation of resection margins using HRCC proves it is a useful tool for predicting excision completeness post-EMR.


Related Articles

  • When Is the Right Time to Repeat Colonoscopy? Boolchand, Vikram // American Family Physician;4/1/2008, Vol. 77 Issue 7, p924 

    The article focuses on the new guidelines on colonoscopy surveillance for patients with post-polypectomy and post-cancer resection surveillance. It states that patients with hereditary nonpolyposis colorectal cancer and the quality of the colonoscopy are some issues that are addressed in the...

  • Association between the Position of Colorectal Polyps and Clinical Outcomes of Polypectomy: Focused on Procedure Time, Complication and Histopatholgic Result. Jung Hyun Park; Jae Hyeok Choi; Hyeong Jung Na; Won Geon Kwak; Jong Sun Choi; Eo Jin Kim; Jae Hak Kim // Intestinal Research;2013, Vol. 11 Issue 3, p191 

    Background/Aims: Colonoscopic polypectomy should be performed on the five to seven hour of clock (standard position). However, outcomes of polypectomy at non-standard positions have not yet been investigated. This study was to compare the clinical outcomes of colonoscopic polypectomy including...

  • Con: Colonoscopic Resection of Large Neoplastic Lesions Is Appropriate and Safe. Soetikno, Roy; Gotoda, Takuji // American Journal of Gastroenterology;Feb2009, Vol. 104 Issue 2, p272 

    The author contends that colonoscopic resection of large neoplastic lesions is appropriate and safe. The author cites several principles that guide efforts to maximize the safety of colonoscopic resection of large neoplastic lesions, including selecting of lesions and use of strategies to...

  • Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: can we change the endoscopic management paradigm? Hurlstone, David P.; Sanders, David S.; Atkinson, Robert; Hunter, Michael D.; McAlindon, M. E.; Lobo, A. J.; Cross, Simon S.; Thomson, Mike // Gut;Jun2007, Vol. 56 Issue 6, p838 

    Background: The potential of endoscopic mucosal resection (EMR) for treating flat dysplastic lesions in chronic ulcerative colitis (CUC) has not been addressed so far. Historically, such lesions were referred for colectomy. Furthermore, there are only limited data to support endoscopic resection...

  • Computed Virtual Chromoendoscopy for Classification of Small Colorectal Lesions: A Prospective Comparative Study. Pohl, Juergen; Nguyen-Tat, Marc; Pech, Oliver; May, Andrea; Rabenstein, Thomas; Ell, Christian // American Journal of Gastroenterology;Mar2008, Vol. 103 Issue 3, p562 

    OBJECTIVES: Standard colonoscopy offers no reliable discrimination between neoplastic and nonneoplastic colorectal lesions. Computed virtual chromoendoscopy with the Fujinon intelligent color enhancement (FICE) system is a new dyeless imaging technique that enhances mucosal and vascular...

  • Hybrid approach for left-sided colonic carcinoma obstruction; a case report. Trakarnsanga, Atthaphorn; Akaraviputh, Thawatchai; Methasate, Asada; Chinswangwatanakul, Vitoon // World Journal of Surgical Oncology;2011, Vol. 9 Issue 1, p42 

    Traditionally, there are several approaches to manage left-sided colonic carcinoma obstruction, such as tumor resection with primary anastomosis, tumor resection with end-colostomy and loop-colostomy. Recently, colonic stent insertion was introduced as a bridge prior to definite surgery. We...

  • Our experience with endoscopic repair of large colonoscopic perforations and review of the literature. Trecca, A.; Gaj, F.; Gagliardi, G. // Techniques in Coloproctology;Dec2008, Vol. 12 Issue 4, p315 

    Colonic perforation is the most severe complication of lower gastrointestinal endoscopy. Recently successful closure with endoscopic clips has been reported. However large (>10 mm) perforations and perforations occurring during diagnostic colonoscopy are considered a contraindication to...

  • Correlation Between Preoperative Endoscopic and Intraoperative Findings in Localizing Colorectal Lesions. Louis, Martine; Nandipati, Kalyana; Astorga, Rakel; Mandava, Anupa; Rousseau, Carl-P.; Mandava, Neil // World Journal of Surgery;Jul2010, Vol. 34 Issue 7, p1587 

    Colonoscopy findings compared with findings at time of surgery have a discrepancy rate of 3–21%. The objective of our study was to investigate this discrepancy and provide potential resolutions. In this retrospective study, we identified 400 patients who underwent colonoscopy followed by...

  • Colonoscopic miss rates determined by direct comparison of colonoscopy with colon resection specimens Postic, Georges; Lewin, David; Bickerstaff, Charles; Wallace, Michael B. // American Journal of Gastroenterology;Dec2002, Vol. 97 Issue 12, p3182 

    OBJECTIVES:Colonoscopy is an effective method for discovery of adenomas and for colon cancer screening and prevention. Studies evaluating back-to-back colonoscopies have estimated significant miss rates but are limited by the lack of a definitive gold standard. Our study evaluated the...


Read the Article


Sign out of this library

Other Topics