TITLE

ASSESSING RESECTION MARGINS USING HIGH MAGNIFICATION CHROMOSCOPY FOR 'EN-BLOCK' COLORECTAL ENDOSCOPIC MUCOSAL RESECTION OF FLAT LESIONS: A USEFUL TOOL FOR PREDICTING REMNANT TISSUE

AUTHOR(S)
Hurlstone, D.P.; Shorthouse, A.J.; Adam, I.; Brown, S.; Cross, S.S.; Korulla, C.; Davies, R.; Lobo, A.J.I.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA23
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
9747414

 

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