Pretreatment Diagnosis of Colorectal T1 Carcinomas that Can Be Completely Resected by Endoscopy: The Usefulness and Limitations of Endoscopic Ultrasonography Yusuke Saitoh 1 , Yuhei Inaba 1 , Shohei Kuroda 1 , Ryuji Sukegawa 1 , Ryuji Sugiyama 1 , Takuya Iwama 1 , Junpei Ikeda 1 , Ken Terasawa 1 , Masaki Taruishi 1 , Yu Kobayashi 2 , Takahiro Sasaki 2 , Mikihiro Fujiya 2 , Jiro Watari 3 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan 2Department of Gastroenterology, Hematology and Oncology, Asahikawa Medical University, Asahikawa, Japan 3Kinentou Hospital, Sapporo, Japan Keyword: 大腸T1b癌 , EUS , 内視鏡的切除 , 内視鏡的軟膜下層剝離術 , ESD pp.1023-1033
Published Date 2021/7/25
DOI https://doi.org/10.11477/mf.1403202502
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 Of the 279 early colorectal carcinomas that underwent EUS (endoscopic ultrasonography)before treatment, the accuracy rate of invasion depth diagnosis was significantly higher in the F&D(flat and depressed)type carcinomas than in the polypoid type carcinomas(87.5% vs 69.2% ; p<0.01). T1b carcinomas, especially F&D type, are good candidates for EUS before treatment. Of the 120 lesions of endoscopically resected T1 carcinomas subjected to the histological measurement of SM(submucosal)invasion distance, the average SM invasion distance of 82 lesions of the polypoid type T1 carcinomas was 3,100μm and that of 38 lesions of the F&D type T1 carcinomas was 1,100μm, indicating a significantly larger(p<0.01)SM invasion distance in the polypoid type. In T1 carcinomas, the cutoff value of the SM invasion distance that can be completely resected using endoscopy was 3,000μm in the polypoid type and 2,000μm in the F&D type. In the 76 T1 carcinomas that underwent both HFUP and conventional endoscopy, the accuracy rate of 3,000μm invasion distance diagnosis in the 22 polypoid-type T1 carcinomas was significantly higher with HFUP than with conventional colonoscopy(86% vs 45% ; p<0.01). Similarly, the SM invasion distance of 2,000μm in the 54 F&D type carcinomas was significantly higher with HFUP than with conventional colonoscopy(86% vs 76% ; p=0.01). Preoperative combined use of EUS can be suggested as an indispensable diagnostic modality for expanding the indications of endoscopic resection for T1b carcinomas in the future.

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