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Diagnosis and Treatment for Minute Adenomas 5 mm or Less in Size Detection and Management Yusuke Saitoh 1 , Jiroh Watari 2 , Masafumi Nomura 1 , Katsuya Einami 1 , Masaki Taruishi 1 1Department of Internal Medicine III, Asahikawa Medical College 2Department of Gastroenterology, Asahikawa Kosei Hospital Keyword: 大腸微小病変 , 過形成 , 微小大腸癌 pp.1477-1484
Published Date 1995/11/25
DOI https://doi.org/10.11477/mf.1403105576
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 Between April, 1991 and March, 1995, 1,830 colorectal minute lesions in 1,090 cases were detected and treated by colonoscopy and made up 48% in all colorectal lesions treated during the same period. These minute lesions were classified according to the criteria of macroscopic type: 890 lesions of type Is, 516 lesions of type Isp, 276 lesions of flat elevated type (type IIa), 88 lesions of type Ip, 51 lesions of flat depressed type (type IIc) and 9 lesions of flat elevated with depression type (type IIa+IIc). In protruded types of Ip, Isp and Is, hyperplastic lesions (non neoplastic lesions) were encountered in 337 lesions (22.6%), whereas cancer was infrequent at incidence of 0.6%, 1.2%, 4.5%, in each macroscopic type. Moreover, minute flat elevated type (type IIa) also had a high rate of the hyperplastic lesions (68 lesions, 24.6%) but a low rate of cancer-like protruded minute lesions (6 lesions, 2.2%). On the contrary, type IIc and type IIa+IIc had a low rate of hyperplastic lesions but cancer rate was high at 21.6%, 11.1% in each type compared with other types of colorectal minute lesions. It was difficult to distinguish intramucosal carcinomas and adenomas in each macroscopic type by x-ray and colonoscopic examination.

 Thus, we recommend as an initial management to perform only biopsy for minute protruded types of Ip, Isp, Is and minute flat elevated type of IIa rather than carry out endoscopic treatment such as polypectomy and endoscopic mucosal resection (EMR). They also say that endoscopic resection immediately after detection is mandatory in flat depressed types of IIc and IIa+IIc.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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