Flat colorectal neoplasms: endoscopic detection, clinical relevance and management

Abstract

The prevalence of flat neoplasms in Western countries appears to be similar to Japan. These lesions are difficult to detect but careful examination of the colonic mucosa with the aid of targeted dye spray reveals subtle mucosal changes characteristic of these lesions. Management of flat neoplasms depends on their size, site and on whether the lesions lift after submucosal injection. In this article, we highlight the typical features of flat neoplasms and discuss their optimal management in routine practice.

Gastroenterologist versus Surgeon Performed Endoscopic Gastrostomy: A Multi-Centre Comparative Study.

“…These deaths may reflect the multiple co-morbidities and poor physiologic status of the patients requiring PEG rather than technical competence. This information supplements existing data proving that surgeons are able to safely and expeditiously place PEG tubes (3,4,14,(21)(22)(23)(24). These data should bring encouragement for appropriately trained surgeons at the UHWI to perform PEG.…”

“…In order to safely perform PEG, surgeons must be appropriately trained and proficient in endoscopic techniques. This type of training has other benefits to surgeons (4,14,(21)(22)(23)(24). Intra-operative endsoscopy is indispensable to evaluate oesophageal calibre during fundoplication or Heller's myotomy and to ensure anastomotic integrity during laparoscopic oesophageal and gastric operations.…”

Systematic review: oral bowel preparation for colonoscopy

“…There is good evidence that flat‐type colorectal cancer develops preferentially in the ascending colon, particularly amongst older patients 101–103 . Diagnosis and treatment at an early stage, however, depends on having a clear view of the mucosa of the ascending colon, in order that dye enhancement techniques can be effectively used 104 . Although it is generally recognized that quality of preparation tends to be poorer in the right colon than the left, of the 82 studies in this review, only 22 attempted a segmental analysis of the quality of bowel preparation.…”

Advances in endoscopic visualization of colorectal polyps

“…However, investigations have demonstrated that 22% of polyps may be missed on the first colonoscopy [5]. Furthermore, flat and depressed lesions are difficult to visualize during conventional colonoscopy and may be missed [6]. Just how sensitive is conventional colonoscopy in detecting these polyps?…”