Accuracy and Pitfalls in the Assessment of Early Gastrointestinal Lesions

Abstract

Superficial neoplastic lesions of the digestive tract are usually asymptomatic, and often represent incidental findings on endoscopy. The Paris Classification was developed for the systematic evaluation of superficial lesions of the oesophagus, stomach and colon. The significance of this classification in clinical practice is that it allows the depth of invasion to be estimated. Chromoendoscopy is used to improve the visualization of gastrointestinal lesions. There are 2 types of chromoendoscopy: dye and virtual chromoendoscopy. In addition to chromoendoscopy, advanced endoscopy techniques have great importance in the detection of early gastrointestinal lesions. Although the depth of invasion can be estimated by endoscopy, the final decision regarding therapeutic approach is made on the basis of histopathological examination, as obtained by biopsy or endoscopic resection (ER). Polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection may be considered ER. For early gastrointestinal lesions with or without limited submucosal infiltration, ER can serve as therapy. In patients with neoplastic lesions localized deeper than the submucosa, or if the location of the lesion carries a high risk of perforation, a full-thickness resection can be performed. Guidelines for assessment and therapy of early oesophageal, gastric and colorectal lesions are currently available.

Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

“…According to the Paris classification, colonic neoplastic lesions stratify into polypoid (pedunculated 0-Ip, sessile 0-Is and semi-pedunculated 0-Isp), non-polypoid (elevated 0-IIa, flat 0-IIb, depressed 0-IIc), and excavated or ulcerated lesions (0-III). 7 IIc and 0-III are depressions less than 1.2 mm and greater 1.2 mm, respectively 8 Utilizing the Paris classification in common practice provides an estimation for depth of invasion. According to the original Paris workshop, of the 3680 colonic lesions, the proportion of invasion into the submucosa was 5% for 0-Ip, 34% for 0-Is, 4% for 0-IIa, 0% for 0-IIb, and 61% for 0-IIc lesions.…”

Endoscopic Classifications of Early Gastric Cancer: A Literature Review

“…Previous studies have shown that the use of the Paris classification during white light endoscopic examination in the detection of EGC has yielded a sensitivity and specificity of 71.2% and 99.1%, respectively [ 11 , 12 ]. Another study showed that the overall accuracy for predicting the invasion depth of EGC based on this classification was 78.0% [ 13 ].…”

Knowledge and awareness of early gastrointestinal cancer screening in Sunan Yugur Autonomous County in Gansu, China

“…3,4 Clinically, early gastrointestinal cancer is classified as early esophageal cancer, early colorectal cancer, and early gastric cancer, depending on the site of the lesion. 5,6 Early screening and diagnosis of gastrointestinal cancer are essential for improving prognosis. Previous studies have revealed a low level of knowledge and awareness regarding screening for early gastrointestinal cancer in China, especially in ethnic minority areas, posing a barrier to early diagnosis and treatment.…”