Background Magnifying narrow‐band imaging (M‐NBI) and magnifying chromoendoscopy (M‐CE) enable accurate diagnosis of T1 colorectal cancer, but the diagnostic yields from combined M‐NBI and CE have not been fully analyzed. We aimed to evaluate the diagnostic yield of combining Japan NBI Expert Team (JNET) classification using M‐NBI and M‐CE. Methods Superficial colorectal lesions ≥10 mm removed at a Japanese tertiary cancer center between February 2016 and December 2018 were included. We analyzed the relationship between JNET classification, M‐CE findings, and histological results based on prospectively collected endoscopic and pathologic data. Results A total of 1573 lesions, including 56 superficial submucosal invasive cancers, 160 deep submucosal invasive cancers, and 81 advanced cancers (≥T2) were analyzed. The probability of deeply invasive cancer (95% confidence interval) was 1.8% (1.1–2.8), 30.1% (25.4–35.1), and 96.6% (91.5–99.1) in JNET Types 2A, 2B, and 3, respectively. The probability of deeply invasive cancer in JNET Type 2B lesions with non‐V, VL, and VH pit pattern was 4.3%, 16.6%, 76.0%, respectively (P < 0.001). Conclusions Our study showed the stratification by M‐NBI using JNET classification and the effect of additional M‐CE for JNET Type 2B lesions.

Endoscopic mucosal resection (EMR) of residual polyps is technically challenging, as submucosal fibrosis from the initial resection makes it difficult to lift the lesion during submucosal injection and to snare the entire tumor [1]. Endoscopic submucosal dissection (ESD) enables complete removal of such residual polyps [2] but presents some technical difficulties and is time-consuming [3]. An 82-year-old man with permanent sigmoidostomy was referred to our unit because of a residual polyp in the descending colon, seen at the 18-month surveillance test after EMR at another hospital. Perforation had occurred during EMR, and clip closure had been performed. Colonoscopy through the sigmoidostomy showed a 12-mm polyp surrounded by multiple widespread scars on the dorsal side 20 cm proximal to the colostomy (▶ Fig. 1). The lesion was diagnosed as an adenoma (▶ Fig. 2 a, b). Complete removal by ESD was considered difficult [4]. First, there was the possibility of severe and widespread submucosal fibrosis because of multiple deep ulcer scars. Second, traction would have to be limited, since it is difficult to change the po-E122 Hosotani Kazuya et al. Underwater EMR for R0 removal of a residual adenoma at a perforated scar … Endoscopy 2017; 49: E121-E122 E-Videos This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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