Endoscopic Diagnosis of Colorectal Diminutive Lesions by Conventional Colonoscopy Yusuke Saitoh 1 , Shinji Tanaka 2 , Osamu Tsuruta 3 , Hiroyuki Kobayashi 4 , Seiji Shimizu 5 , Sumio Tsuda 6 , Ichiro Hirata 7 , Shin-ei Kudo 8 , Akinori Iwashita 9 , Mikihiro Fujiya 10 , Masahiro Tada 11 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan 2Endoscopy and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan 3Digestive Disease Center and GI Endoscopy, Kurume University Hospital, Kurume, Japan 4Institute of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan 5Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan 6General Health Examination Center, Okayama Saiseikai General Hospital, Okayama, Japan 7Department of Gastroenterology, Kenporen Osaka Central Hospital, Osaka, Japan 8Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan 9Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 10Division of Gastroenterology and Hematology/Oncology Department of Medicine, Asahikawa Medical University, Asahikawa, Japan 11Tada Clinic, Kyoto, Japan Keyword: 大腸微小病変 , 微小大腸癌 , 通常内視鏡診断 , 内視鏡治療 pp.1526-1533
Published Date 2017/11/25
DOI https://doi.org/10.11477/mf.1403201211
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 To elucidate the colonoscopic characteristics of colorectal diminutive(5mm or smaller)carcinomas, a multicenter prospective study involving conventional colonoscopic findings(using indigocarmine dye spray)was performed for 161 colorectal diminutive lesions with established histological diagnoses(polypoid:69, flat elevated:69, slightly depressed:31 ; histological type:hyperplastic:10, adenoma:105, Tis:36, T1 carcinomas:10). The concordance ratio between the colonoscopic and histological diagnoses for the discrimination between adenoma and hyperplastic and between carcinoma and non-carcinoma were 93.0%±2.7% and 83.2%±3.2%, respectively. The results of the multivariate analysis showed that expansion appearance, sessile lesion with normal mucosal border, the presence of depression surface, uneven depression surface, and rough surface structure were found at a significantly high rate in the colonoscopic findings in carcinomas than in adenomas. When a diminutive colorectal lesion is detected, attention should be paid to the 5 conventional colonoscopic findings mentioned above. In addition, the indigocarmine dye method or a magnifying colonoscopy should be used to confirm whether the 5 colonoscopic findings are present. If one or more colonoscopic findings are present, diminutive colorectal carcinoma, including T1 carcinoma, should be considered. The carcinoma should not be resected by cold polypectomy, but a complete resection method, such as EMR, should be considered.

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