caa a22 4500 475801792 CHVBK 20180406123739.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s002680010154 doi (NATIONALLICENCE)springer-10.1007/s002680010154 Colonoscopic Diagnosis and Management of Nonpolypoid EarlyColorectal Cancer [Elektronische Daten] [Shin-ei Kudo, Hiroshi Kashida, Tomoyuki Tamura, Etsuko Kogure, Yasushi Imai, Hiro-o Yamano, Andrew R. Hart] Nonpolypoid colorectal neoplasms are grossly classified into three groups: slightly elevated (small flat adenomas), laterally spreading, and depressed. Flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when they are extremely small. Nonpolypoid lesions are difficult to detect and are often overlooked. Keys to detect them are their slight color change, interruption of the capillary network pattern, slight deformation of the colonic wall, spontaneously bleeding spots, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves. Spraying of indigo carmine dye helps to clarify the lesions. A pit pattern analysis with a zoom colonoscope is useful for the diagnosis and staging of early colorectal cancer. Small flat adenomas are thought to be precursors of protruded polyps and lateral spreading tumors, whereas depressed lesions are thought to grow endophytically and become advanced cancers. Small depressed lesions are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Laterally spreading tumors are not as invasive despite their large size and therefore are good indications for the EMR or piecemeal EMR method. Small flat adenomas need not be treated urgently, as almost none is invasive. Accurate diagnosis with dye-spraying and zoom colonoscopy is vital for deciding the treatment strategy. Société Internationale de Chirurgie, 2000 Kudo Shin-ei Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut Kashida Hiroshi Division of Gastroenterology, Kobe City General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe 650-0046, Japan aut Tamura Tomoyuki Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut Kogure Etsuko Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut Imai Yasushi Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut Yamano Hiro-o Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut Hart Andrew R. Gastroenterology Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom aut World Journal of Surgery Springer-Verlag 24/9(2000-09-01), 1081-1090 0364-2313 24:9<1081 2000 24 268 https://doi.org/10.1007/s002680010154 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002680010154 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kudo Shin-ei Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut NATIONALLICENCE 700 1- Kashida Hiroshi Division of Gastroenterology, Kobe City General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe 650-0046, Japan aut NATIONALLICENCE 700 1- Tamura Tomoyuki Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut NATIONALLICENCE 700 1- Kogure Etsuko Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut NATIONALLICENCE 700 1- Imai Yasushi Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut NATIONALLICENCE 700 1- Yamano Hiro-o Division of Gastroenterology, Akita Red Cross Hospital,, 222-1 Aza-Naeshirosawa, Saruta, Kamikitade, Akita 010-1495, Japan aut NATIONALLICENCE 700 1- Hart Andrew R. Gastroenterology Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/9(2000-09-01), 1081-1090 0364-2313 24:9<1081 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer