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Review
Classification of image-enhanced endoscopy in colon tumors
One-Zoong Kim
Received September 30, 2024  Accepted December 13, 2024  Published online May 8, 2025  
DOI: https://doi.org/10.5946/ce.2024.263    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Colorectal cancer accounts for 10% of global cancer cases in each year, making accurate evaluation and resection crucial. Imaging-enhanced endoscopy helps differentiate between hyperplastic polyps and adenomas, guiding treatment decisions. Colon tumors are classified into benign (e.g., serrated and adenomatous polyps) and malignant (e.g., adenocarcinomas). The Paris classification categorizes superficial neoplastic lesions by morphology, while laterally spreading tumors are classified by size and growth pattern. Effective classification aids in determining resectability and appropriate interventions for colon tumors, ultimately improving patient outcomes. Image-enhanced endoscopy improves colon tumor diagnosis using various techniques like dye, optical, and electronic methods. Kudo’s pit pattern categorizes lesions based on surface morphology using dye, while Sano, Jikei, and Hiroshima classifications focus on vascular patterns using narrow-band imaging (NBI). The NBI International Colorectal Endoscopic (NICE) classification integrates these methods to identify lesions, especially deep submucosal invasive cancers. The Workgroup Serrated Polyps and Polyposis (WASP) classification targets sessile serrated lesions, and the Japan NBI Expert Team (JNET) classification further refines adenoma categorization with low- and high-grade adenoma. The Colorectal Neoplasia Endoscopic Classification to Choose the Treatment (CONECCT) classification consolidates multiple systems for comprehensive assessment, aiding in treatment decisions and potentially applicable to artificial intelligence for diagnostic validation across imaging modalities like linked color imaging, blue light imaging, or i-scan.
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Original Articles
Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
Jung-Bin Park, Jung Ho Bae
Clin Endosc 2025;58(1):112-120.   Published online August 5, 2024
DOI: https://doi.org/10.5946/ce.2024.168
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: The real-world effectiveness of computer-aided detection (CADe) systems during colonoscopies remains uncertain. We assessed the effectiveness of the novel CADe system, ENdoscopy as AI-powered Device (ENAD), in enhancing the adenoma detection rate (ADR) and other quality indicators in real-world clinical practice.
Methods
We enrolled patients who underwent elective colonoscopies between May 2022 and October 2022 at a tertiary healthcare center. Standard colonoscopy (SC) was compared to ENAD-assisted colonoscopy. Eight experienced endoscopists performed the procedures in randomly assigned CADe- and non-CADe-assisted rooms. The primary outcome was a comparison of ADR between the ENAD and SC groups.
Results
A total of 1,758 sex- and age-matched patients were included and evenly distributed into two groups. The ENAD group had a significantly higher ADR (45.1% vs. 38.8%, p=0.010), higher sessile serrated lesion detection rate (SSLDR) (5.7% vs. 2.5%, p=0.001), higher mean number of adenomas per colonoscopy (APC) (0.78±1.17 vs. 0.61±0.99; incidence risk ratio, 1.27; 95% confidence interval, 1.13–1.42), and longer withdrawal time (9.0±3.4 vs. 8.3±3.1, p<0.001) than the SC group. However, the mean withdrawal times were not significantly different between the two groups in cases where no polyps were detected (6.9±1.7 vs. 6.7±1.7, p=0.058).
Conclusions
ENAD-assisted colonoscopy significantly improved the ADR, APC, and SSLDR in real-world clinical practice, particularly for smaller and nonpolypoid adenomas.

Citations

Citations to this article as recorded by  
  • Role of Artificial Intelligence in Improving Quality of Colonoscopy
    Ji Hyun Kim, Sung Chul Park, Hyun-Soo Kim
    The Korean Journal of Gastroenterology.2025; 85(2): 137.     CrossRef
  • Usefulness of an artificial intelligence-based colonoscopy report generation support system
    Tatsushi Naito, Takuto Nosaka, Tomoko Tanaka, Yu Akazawa, Kazuto Takahashi, Masahiro Ohtani, Yasunari Nakamoto
    Clinical Endoscopy.2025; 58(2): 327.     CrossRef
  • Impact of Artificial Intelligence on Polyp Size and Surveillance Colonoscopy: A Phantom Study
    Muhammad N Yousaf, Neal Sharma, Michelle L Matteson-Kome, Srinivas Puli, Douglas Nguyen, Matthew L Bechtold
    Cureus.2024;[Epub]     CrossRef
  • Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
    Biomimetics.2024; 9(12): 783.     CrossRef
  • 3,651 View
  • 317 Download
  • 4 Web of Science
  • 4 Crossref
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Endoscopic management of giant colonic polyps: a retrospective Italian study
Paolo Quitadamo, Sara Isoldi, Germana De Nucci, Giulia Muzi, Flora Caruso
Clin Endosc 2024;57(4):501-507.   Published online June 5, 2024
DOI: https://doi.org/10.5946/ce.2023.229
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Polyps greater than 30 mm are classified as “giants”. Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes.
Methods
From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery.
Results
We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications.
Conclusions
We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

Citations

Citations to this article as recorded by  
  • Endoscopic approaches for the management of giant colonic polyps
    Yunho Jung
    Clinical Endoscopy.2024; 57(4): 468.     CrossRef
  • 3,687 View
  • 237 Download
  • 1 Web of Science
  • 1 Crossref
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Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand
Kasenee Tiankanon, Julalak Karuehardsuwan, Satimai Aniwan, Parit Mekaroonkamol, Panukorn Sunthornwechapong, Huttakan Navadurong, Kittithat​ Tantitanawat, Krittaya Mekritthikrai, Salin Samutrangsi, Peerapon Vateekul, Rungsun Rerknimitr
Clin Endosc 2024;57(2):217-225.   Published online February 7, 2024
DOI: https://doi.org/10.5946/ce.2023.145
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model.
Methods
Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen.
Results
In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%.
Conclusions
Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.

Citations

Citations to this article as recorded by  
  • Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
    Jung-Bin Park, Jung Ho Bae
    Clinical Endoscopy.2025; 58(1): 112.     CrossRef
  • Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
    Jung Ho Bae
    Clinical Endoscopy.2024; 57(6): 765.     CrossRef
  • Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
    Biomimetics.2024; 9(12): 783.     CrossRef
  • 3,520 View
  • 172 Download
  • 4 Web of Science
  • 3 Crossref
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Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy
Suleyman Dolu, Soner Onem, Zarni Htway, Farid Hajıyev, Ali Bilgen, Hatice Cilem Binicier, Ecem Kalemoglu, Ozgul Sagol, Mesut Akarsu
Clin Endosc 2023;56(1):83-91.   Published online October 27, 2022
DOI: https://doi.org/10.5946/ce.2022.131
AbstractAbstract PDFPubReaderePub
Background
/Aims: Double-balloon enteroscopy (DBE) allows for the diagnoses and treatment of small bowel tumors (SBTs). This study aimed to evaluate the utility of DBE for the diagnosis and treatment of SBTs.
Methods
Patients diagnosed with SBTs who underwent DBE were included in this study. According to their endoscopic appearances, they were categorized as polyps or masses, and according to their histological characteristics, they were categorized as benign or malignant SBTs.
Results
A total of 704 patients were retrospectively analyzed, and 90 (12.8%) were diagnosed with SBTs. According to their endoscopic appearance, 48 (53.3%) had polyps and 42 (46.7%) had masses. Additionally, 53 (58.9%) and 37 (41.1%) patients had malignant and benign SBTs, respectively, depending on their histological characteristics. Patients diagnosed with polyps were younger than those diagnosed with masses (p<0.001). Patients diagnosed with benign SBTs were younger than those diagnosed with malignant SBT (p<0.001). Overall, histological diagnosis was determined using DBE in 73 (81.1%) patients.
Conclusions
DBE is a useful method for diagnosing SBTs. Additionally, the histological type of the lesion can be determined using DBE.

Citations

Citations to this article as recorded by  
  • Effectiveness of Double Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Varices
    Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Ilker Buyuktorun, Huseyin Dongelli, Goksel Bengi, Mesut Akarsu
    Diagnostics.2025; 15(3): 336.     CrossRef
  • Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
    Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
    Surgical Endoscopy.2025; 39(3): 2044.     CrossRef
  • Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population
    Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Huseyin Dongelli, Mesut Akarsu
    Diagnostics.2025; 15(6): 661.     CrossRef
  • Small Bowel Tumors: A 7-Year Study in a Tertiary Care Hospital
    Sergiu Marian Cazacu, Dan Cârțu, Mihai Popescu, Liliana Streba, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Mihai Cimpoeru, Cecil Sorin Mirea, Valeriu Marian Surlin, Stelian Mogoantă, Mirela Marinela Florescu
    Cancers.2025; 17(9): 1465.     CrossRef
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  • 6 Web of Science
  • 4 Crossref
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Factors influencing endoscopic estimation of colon polyp size in a colon model
Koen Robert Beukema, Jaimy A. Simmering, Marjolein Brusse-Keizer, Sneha John, Rutger Quispel, Peter B. Mensink
Clin Endosc 2022;55(4):540-548.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2022.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation.
Methods
Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp.
Results
Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size.
Conclusions
Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

Citations

Citations to this article as recorded by  
  • Endoscopic size measurement of colorectal polyps: a systematic review of techniques
    Mahsa Taghiakbari, Roupen Djinbachian, Juliette Labelle, Daniel von Renteln
    Endoscopy.2025; 57(05): 460.     CrossRef
  • Taking the Guess Work Out of Endoscopic Polyp Measurement
    Anthony Kerbage, Tarek Souaid, Kailash Singh, Carol A. Burke
    Journal of Clinical Gastroenterology.2025;[Epub]     CrossRef
  • Accuracy of Visual Estimation for Measuring Colonic Polyp Size: A Systematic Review and Meta-Analysis
    Abraham Z. Cheloff, Leah Kim, Mark B. Pochapin, Aasma Shaukat, Violeta Popov
    American Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size
    Yudai Takehara, Ken Yamashita, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Yuki Kamigaichi, Hidenori Tanaka, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
    Digestion.2024; 105(2): 73.     CrossRef
  • Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study
    Ioana Popescu Crainic, Roupen Djinbachian, Douglas K. Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C. Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
    Scandinavian Journal of Gastroenterology.2024; 59(5): 608.     CrossRef
  • 4,449 View
  • 147 Download
  • 2 Web of Science
  • 5 Crossref
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Review
Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art
Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma
Clin Endosc 2022;55(2):183-190.   Published online February 24, 2022
DOI: https://doi.org/10.5946/ce.2021.254
AbstractAbstract PDFPubReaderePub
Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

Citations

Citations to this article as recorded by  
  • Virtual Colonoscopy: Retrospective Comparison of the Findings in Supine and Prone Positions
    Mehmet Gürdal Demirci, Yasir Musa Kesgin
    Surgical Innovation.2025;[Epub]     CrossRef
  • Spectroscopic Nuclear Magnetic Resonance and Fourier Transform–Infrared Approach Used for the Evaluation of Healing After Surgical Interventions for Patients with Colorectal Cancer: A Pilot Study
    Lavinia Raluca Șaitiș, David Andras, Ioana-Alina Pop, Cătălin Șaitiș, Ramona Crainic, Radu Fechete
    Cancers.2025; 17(5): 887.     CrossRef
  • DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk—multicentre retrospective study
    Mohamed Talaat Issa, Emiko Sultana, Mohammed Hamid, Ali Yasen Mohamedahmed, Mohamed Albendary, Shafquat Zaman, Santosh Bhandari, William Ball, Sangara Narayanasamy, Pradeep Thomas, Najam Husain, Rajeev Peravali, Diwakar Sarma
    International Journal of Colorectal Disease.2025;[Epub]     CrossRef
  • Advances in colorectal cancer screening and detection: a narrative review on biomarkers, imaging and preventive strategies
    Adil khan, Uswa Hasana, Iman Anum Nadeem, Swara Punit Khatri, Shayan Nawaz, Qurat Ulain Makhdoom, Shahab Wazir, Kirtan Patel, Mohamd Ghaly
    Journal of the Egyptian National Cancer Institute.2025;[Epub]     CrossRef
  • Multi-view orientational attention network combining point-based affinity for polyp segmentation
    Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
    Expert Systems with Applications.2024; 249: 123663.     CrossRef
  • The Influence of Mechanical Bowel Preparation on Volatile Organic Compounds for the Detection of Gastrointestinal Disease—A Systematic Review
    Ashwin Krishnamoorthy, Subashini Chandrapalan, Sofie Bosch, Ayman Bannaga, Nanne K.H. De Boer, Tim G.J. De Meij, Marcis Leja, George B. Hanna, Nicoletta De Vietro, Donato Altomare, Ramesh P. Arasaradnam
    Sensors.2023; 23(3): 1377.     CrossRef
  • The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis
    Inese Poļaka, Linda Mežmale, Linda Anarkulova, Elīna Kononova, Ilona Vilkoite, Viktors Veliks, Anna Marija Ļeščinska, Ilmārs Stonāns, Andrejs Pčolkins, Ivars Tolmanis, Gidi Shani, Hossam Haick, Jan Mitrovics, Johannes Glöckler, Boris Mizaikoff, Mārcis Lej
    Diagnostics.2023; 13(21): 3355.     CrossRef
  • 5,481 View
  • 268 Download
  • 9 Web of Science
  • 7 Crossref
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Case Report
Less invasive transoral resection of esophageal fibrovascular polyps: case reports
Janusz Włodarczyk, Tomasz Smęder
Clin Endosc 2022;55(5):683-687.   Published online December 6, 2021
DOI: https://doi.org/10.5946/ce.2021.144
AbstractAbstract PDFPubReaderePub
We report five patients treated for esophageal fibrovascular polyps using a minimally invasive technique. Esophageal fibrovascular polyps are benign pedunculated submucosal tumors of considerable size. The treated polyps size ranged from 1.5 to 13 cm. The polyps were removed by relocation to the oral cavity under endoscopic control. No perioperative complications occurred after the treatment. The follow-up of patients after surgery was 9–89 months, with no evidence of polyp recurrence. Thus, the described treatment is safe but requires experience with endoscopy as well as esophageal surgery.

Citations

Citations to this article as recorded by  
  • A case of esophageal fibrous polyp treated by suspended laryngoscope in the department of otorhinolaryngology
    Fengling Yang, Zhenhua Jiang, Qian He, Shuangyan He
    Asian Journal of Surgery.2025;[Epub]     CrossRef
  • 3,936 View
  • 180 Download
  • 1 Crossref
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Original Articles
Artificial Intelligence-Based Colorectal Polyp Histology Prediction by Using Narrow-Band Image-Magnifying Colonoscopy
Istvan Racz, Andras Horvath, Noemi Kranitz, Gyongyi Kiss, Henriett Regoczi, Zoltan Horvath
Clin Endosc 2022;55(1):113-121.   Published online September 23, 2021
DOI: https://doi.org/10.5946/ce.2021.149
AbstractAbstract PDFPubReaderePub
Background
/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods.
Methods
We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image.
Results
The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001)
Conclusions
Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

Citations

Citations to this article as recorded by  
  • Colon polyps: updates in classification and management
    David Dornblaser, Sigird Young, Aasma Shaukat
    Current Opinion in Gastroenterology.2024; 40(1): 14.     CrossRef
  • Employing deep learning for predicting the thermal properties of water and nano-encapsulated phase change material
    Saihua Xu, Ali Basem, Hasan A Al-Asadi, Rishabh Chaturvedi, Gulrux Daminova, Yasser Fouad, Dheyaa J Jasim, Javid Alhoee
    International Journal of Low-Carbon Technologies.2024; 19: 1453.     CrossRef
  • Endoscopic Artificial Intelligence for Image Analysis in Gastrointestinal Neoplasms
    Ryosuke Kikuchi, Kazuaki Okamoto, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara, Tomohiro Tada
    Digestion.2024; 105(6): 419.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
    Donghwan Kim, Eunsun Kim
    Journal of the Korean Medical Association.2023; 66(11): 658.     CrossRef
  • Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps
    Naoki Muguruma, Tetsuji Takayama
    Clinical Endoscopy.2022; 55(1): 45.     CrossRef
  • Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
    Ji Young Chang
    Clinical Endoscopy.2022; 55(5): 699.     CrossRef
  • Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
    Istvan Racz, Andras Horvath, Zoltán Horvath
    Clinical Endoscopy.2022; 55(5): 701.     CrossRef
  • 5,738 View
  • 216 Download
  • 8 Web of Science
  • 8 Crossref
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Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis
Rajat Garg, Amandeep Singh, Manik Aggarwal, Jaideep Bhalla, Babu P. Mohan, Carol Burke, Tarun Rustagi, Prabhleen Chahal
Clin Endosc 2021;54(3):379-389.   Published online April 29, 2021
DOI: https://doi.org/10.5946/ce.2020.276
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Citations

Citations to this article as recorded by  
  • Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
    Hye Kyung Jeon, Gwang Ha Kim
    Gut and Liver.2025; 19(1): 19.     CrossRef
  • Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials
    Raffaele Pellegrino, Giovanna Palladino, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Alessandro Federico, Antonietta Gerarda Gravina
    World Journal of Gastrointestinal Endoscopy.2024; 16(12): 647.     CrossRef
  • Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy
    Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
    JGH Open.2024;[Epub]     CrossRef
  • Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps
    Karl Kwok, Sasan Mosadeghi, Daniel Lew
    Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(4): 361.     CrossRef
  • Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials
    Matheus Henrique Gonçalves de Souza, Paula Arruda do Espirito Santo, Fauze Maluf-Filho, Luciano Lenz
    International Journal of Colorectal Disease.2023;[Epub]     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • EMR and ESD: Indications, techniques and results
    Mamoon Ur Rashid, Mohammad Alomari, Sadaf Afraz, Tolga Erim
    Surgical Oncology.2022; 43: 101742.     CrossRef
  • Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions
    Andrew W. Yen, Joseph W. Leung, Malcom Koo, Felix W. Leung
    Endoscopy International Open.2022; 10(06): E791.     CrossRef
  • Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?
    Li‐Chun Chang
    Advances in Digestive Medicine.2021; 8(3): 133.     CrossRef
  • 6,580 View
  • 162 Download
  • 10 Web of Science
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Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?
Ji Hyun Song, Shai Friedland
Clin Endosc 2021;54(3):397-403.   Published online February 9, 2021
DOI: https://doi.org/10.5946/ce.2020.226
AbstractAbstract PDFPubReaderePub
Background
/Aims: Cold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps.
Methods
Between 2018 and 2019, 100 consecutive small colorectal polyps (5–10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected.
Results
No difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006–1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, 3.853–322.397) showed a significantly increased risk of bleeding.
Conclusions
The effect of submucosal injection in CSP was not significant for small colorectal polyps.

Citations

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Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study
Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim
Clin Endosc 2021;54(3):390-396.   Published online September 10, 2020
DOI: https://doi.org/10.5946/ce.2020.096
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

Citations

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    Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
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Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding
Ari Silbermintz, Manar Matar, Amit Assa, Noam Zevit, Yael Mozer Glassberg, Raanan Shamir
Clin Endosc 2019;52(3):258-261.   Published online May 14, 2019
DOI: https://doi.org/10.5946/ce.2018.046
AbstractAbstract PDFPubReaderePub
Background
/Aims: Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort.
Methods
We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study.
Results
A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon.
Conclusions
Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

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Review
Should We Resect and Discard Low Risk Diminutive Colon Polyps
Pujan Kandel, Michael B. Wallace
Clin Endosc 2019;52(3):239-246.   Published online January 21, 2019
DOI: https://doi.org/10.5946/ce.2018.136
AbstractAbstract PDFPubReaderePub
Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.

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Original Article
Mis-sizing of Adenomatous Polyps is Common among Endoscopists and Impacts Colorectal Cancer Screening Recommendations
Thu Pham, Aung Bajaj, Lorela Berberi, Chengcheng Hu, Sasha Taleban
Clin Endosc 2018;51(5):485-490.   Published online June 21, 2018
DOI: https://doi.org/10.5946/ce.2017.183
AbstractAbstract PDFPubReaderePub
Background
/Aims: To determine the accuracy of identifying ≥6-mm adenomatous polyps during colonoscopy and define its impact on subsequent interval screening.
Methods
We conducted a retrospective study of patients who underwent colonoscopies at Banner University Medical Center, Tucson from 2011 to 2015. All patients with ≥6-mm adenomatous polyps based on their colonoscopy report were included. Adenomatous polyps were excluded if they did not meet the criteria. Discrepancies in the polyp size were determined by calculating the percentage of size variation (SV). Clinical mis-sizing was defined as SV >33%.
Results
The polyps analyzed were predominantly <10 mm in size. Approximately 13% of the examined polyps met the inclusion criteria, and 40.7% of the adenomas were ≥10 mm. A total of 189 ≥6-mm adenomatous polyps were collected from 10 different gastroenterologists and a colorectal surgeon. Adenomatous polyps were clinically mis-sized in 56.6% of cases and overestimated in 71.4%. Among the adenomas reviewed, 22% of mis-sized polyps and 11% of non-mis-sized polyps resulted in an inappropriate surveillance interval.
Conclusions
We found that more than half of ≥6-mm adenomatous polyps are mis-sized and that there is a tendency to overestimate adenoma size among endoscopists. This frequently leads to inappropriate intervals of surveillance colonoscopy.

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Case Report
Primary Colonic Follicular Lymphoma Presenting as Four Diminutive Sessile Polyps Found Incidentally During Colonoscopy
Sun Jin, Hyun Seok Lee, Ji Yun Jeong, Young Wook Jo
Clin Endosc 2018;51(4):388-392.   Published online April 18, 2018
DOI: https://doi.org/10.5946/ce.2017.114
AbstractAbstract PDFPubReaderePub
Follicular lymphomas, which typically arise in the lymph nodes with spleen, liver, and bone marrow involvement, have generally low occurrence rates in Asian countries as compared with Western countries. Follicular lymphomas of the gastrointestinal tract are rare, and primary colonic follicular lymphomas are particularly rare compared with others found in the small intestine and duodenum. Colonoscopic imaging of colonic lymphomas, including follicular lymphoma, may reveal mucosal ulcerations, erosions, indurations, polypoid mass-like lesions, and diffuse mucosal nodularity. Herein, we report a unique case of a follicular lymphoma of the transverse colon characterized by four sessile diminutive polyps located intermittently with multiple lymph node involvement in a 62-year-old man.

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Reviews
Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist’s View
Ian Holmes, Shai Friedland
Clin Endosc 2016;49(5):454-456.   Published online August 26, 2016
DOI: https://doi.org/10.5946/ce.2016.077
AbstractAbstract PDFPubReaderePub
To discuss the rationale for the widespread application of endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) in Western centers. In Western centers, EMR is the treatment of choice for most non-pedunculated colorectal adenomas >2 cm in size. EMR is sufficiently effective and safe to be performed without post-procedure hospitalization. Advances in EMR have led to reduced recurrence rates, and recent studies have demonstrated excellent outcomes with endoscopic treatment of recurrent adenomas. While studies from Asia have demonstrated lower recurrence rates with ESD, concern about the higher perforation risk and lengthy procedure time of ESD are two of the barriers preventing widespread adoption of ESD in the West. EMR is likely to continue as the dominant method for the treatment of large colorectal adenomas in Western centers until the limitations of ESD are overcome.

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Resection of Diminutive and Small Colorectal Polyps: What Is the Optimal Technique?
Jun Lee
Clin Endosc 2016;49(4):355-358.   Published online July 22, 2016
DOI: https://doi.org/10.5946/ce.2016.063
AbstractAbstract PDFPubReaderePub
Colorectal polyps are classified as neoplastic or non-neoplastic on the basis of malignant potential. All neoplastic polyps should be completely removed because both the incidence of colorectal cancer and the mortality of colorectal cancer patients have been found to be strongly correlated with incomplete polypectomy. The majority of colorectal polyps discovered on diagnostic colonoscopy are diminutive and small polyps; therefore, complete resection of these polyps is very important. However, there is no consensus on a method to remove diminutive and small polyps, and various techniques have been adopted based on physician preference. The aim of this article was to review the diverse techniques used to remove diminutive and small polyps and to suggest which technique will be the most effective.

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  • Real-Time Polyp Detection, Localization and Segmentation in Colonoscopy Using Deep Learning
    Debesh Jha, Sharib Ali, Nikhil Kumar Tomar, Havard D. Johansen, Dag Johansen, Jens Rittscher, Michael A. Riegler, Pal Halvorsen
    IEEE Access.2021; 9: 40496.     CrossRef
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    Julián Parga, William Otero Regino, Martín Alonso Gómez Zuleta
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    Yoon Suk Jung, Chan Hyuk Park, Eunwoo Nam, Chang Soo Eun, Dong Il Park, Dong Soo Han
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    Tan Le Minh, Thuong Nguyen Thi Huyen, Huy Tran Van
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Original Articles
Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light
Woo Jung Kim, Sang Young Park, Iksoo Park, Wook Jin Lee, Jaechan Park, Nuri Chon, Tak Geun Oh, Kwang Hyun Kim
Clin Endosc 2016;49(1):69-75.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.69
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy.
Methods
We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed.
Results
The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007).
Conclusions
Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

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    M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
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    Wee Sing Ngu, Colin Rees
    Therapeutic Advances in Gastroenterology.2018;[Epub]     CrossRef
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    Antonio Rodríguez-D´Jesus, Esteban Saperas
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  • 106 Download
  • 7 Web of Science
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The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps
Da Kyoung Jung, Tae Oh Kim, Mi Seon Kang, Mo Se Kim, Min Sik Kim, Young Soo Moon
Clin Endosc 2016;49(1):61-68.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.61
AbstractAbstract PDFPubReaderePub
Background
/Aims: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.
Methods
We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.
Results
No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.
Conclusions
Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

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    Yan Wen, Lei Zhang, Xiangli Meng, Xujiong Ye
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    Emad Qayed, Ravi Vora, Sara Levy, Roberd M Bostick
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Focused Review Series: Image Enhanced Endoscopy
Polyp Detection, Characterization, and Management Using Narrow-Band Imaging with/without Magnification
Takahiro Utsumi, Mineo Iwatate, Wataru Sano, Hironori Sunakawa, Santa Hattori, Noriaki Hasuike, Yasushi Sano
Clin Endosc 2015;48(6):491-497.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.491
AbstractAbstract PDFPubReaderePub
Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.

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  • Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines
    Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong-Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, Eun R
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    Seong Ji Choi, Eun Sun Kim, Kihwan Choi
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    Sandra Barbeiro, Diogo Libânio, Rui Castro, Mário Dinis-Ribeiro, Pedro Pimentel-Nunes
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    John F. Sullivan, John A. Dumot
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    Łukasz Pietrzyk
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    Céline Audibert, Anna Perlaky, Daniel Glass
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Original Article
Endoscopic Mucosal Resection with Circumferential Incision for the Treatment of Large Sessile Polyps and Laterally Spreading Tumors of the Colorectum
Young Mi Hong, Hyung Wook Kim, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang
Clin Endosc 2015;48(1):52-58.   Published online January 31, 2015
DOI: https://doi.org/10.5946/ce.2015.48.1.52
AbstractAbstract PDFPubReaderePub
Background/Aims

Endoscopic mucosal resection (EMR) is the standard treatment for colorectal polyps such as adenomas and early cancers with no risk of lymph node metastasis. However, endoscopic resection of large colorectal polyps (≥20 mm diameter) is difficult to perform. We evaluated the clinical outcomes of EMR with circumferential incision (EMR-CI) for the resection of large sessile polyps (Is) and laterally spreading tumors (LSTs) in the colorectum.

Methods

Between February 2009 and March 2011, we resected 80 large colorectal polyps by EMR-CI. We retrospectively investigated the en bloc resection rate, histologic complete resection rate, recurrence rate, and complications.

Results

The median polyp size was approximately 25 mm (range, 20 to 50), and the morphologic types included Is (13 cases), LST-granular (37 cases), and LST-nongranular (30 cases). The en bloc and complete histologic resection rates were 66.3% and 45.0%, respectively. The recurrence rate was 0% (median follow-up duration, 23 months), and perforation occurred in five cases (6.3%).

Conclusions

EMR-CI is an effective treatment modality for 20 to 30 mm-sized colorectal polyps, and may be considered as a second line therapeutic option if ESD is difficult.

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    Shin Morimoto, Hidenori Tanaka, Yudai Takehara, Noriko Yamamoto, Fumiaki Tanino, Yuki Kamigaichi, Ken Yamashita, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
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    Mahsa Taghiakbari, Dong Hyun Danny Kim, Roupen Djinbachian, Daniel von Renteln
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    Shinji Yoshii, Takefumi Kikuchi, Yuki Hayashi, Masahiro Nojima, Hiro-o Yamano, Hiroshi Nakase
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Case Reports
Gastric Squamous Papilloma in a 52-Year-Old Female Patient
Hyung Ha Jang, Hyung Wook Kim, Su Jin Kim, Choel Woong Choi, Su Bum Park, Byeong Jun Song, Dong Hoon Shin, Dae Hwan Kang
Clin Endosc 2014;47(6):571-574.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.571
AbstractAbstract PDFPubReaderePub

A papilloma is a benign epithelial lesion characterized by finger-like projections of tissue lined by an overgrowth of squamous cells and a core of connective tissue. We report a case of squamous papilloma on the cardia in a 52-year-old asymptomatic female. Endoscopy showed a 1-cm sized is polyp with hyperemic change originating from the cardia adjacent to the esophagogastric junction, the biopsy of which suggested a diagnosis of squamous papilloma. Endoscopic mucosal resection was performed to obtain a definite diagnosis and the polyp was completely removed. The histological result was compatible with squamous papilloma, and its surrounding tissues showed foveolar epithelium, which suggested a stomach origin. This is the first report of endoscopic resection of a gastric squamous papilloma. Squamous papilloma should be considered in the differential diagnosis of a gastric polyp, especially one in the cardia. As the prognostic value of a squamous papilloma is not well known, we recommend endoscopic resection to treat a gastric squamous papilloma, when possible.

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  • Overexpression of Neutrophil MMP-9 and HIF-1α May Contribute to the Finger-Like Projections Formation and Histo-Pathogenesis in Nasal Inverted Papilloma
    Tao Li, Kai Sen Tan, Yan Yi Tu, Li Zhao, Jing Liu, Hsiao Hui Ong, De Yun Wang, Li Shi
    Journal of Inflammation Research.2021; Volume 14: 2979.     CrossRef
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  • 76 Download
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A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of the Sigmoid Colon Presenting as a Semipedunculated Polyp
Myung Hwan Kim, Jin Tae Jung, Eui Jung Kim, Tae Won Kim, Seon Young Kim, Joong Goo Kwon, Eun Young Kim, Woo Jung Sung
Clin Endosc 2014;47(2):192-196.   Published online March 31, 2014
DOI: https://doi.org/10.5946/ce.2014.47.2.192
AbstractAbstract PDFPubReaderePub

Mucosa-associated lymphoid tissue (MALT) lymphomas are characterized by lymphoepithelial lesions pathologically. Colonic MALT lymphomas are relatively rarer than lymphomas of the stomach or small intestine. Endoscopically, colonic MALT lymphoma frequently appears as a nonpedunculated protruding polypoid mass and/or an ulceration in the cecum and/or rectum. We report a unique case of a colonic MALT lymphoma presenting as a semipedunculated polyp. A 54-year-old man was found to have a 2-cm semipedunculated polyp in the sigmoid colon during screening colonoscopy. The polyp was removed by endoscopic mucosal resection. Histologic examination of the resected polyp revealed diffuse epithelial infiltration by discrete aggregates of lymphoma cells. We diagnosed the tumor as low-grade B-cell MALT lymphoma by immunohistochemical staining.

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Original Article
Diagnostic Yield and Therapeutic Impact of Rectal Retroflexion: A Prospective, Single-Blind Study Conducted in Three Centers
Félix Téllez-Ávila, Josué Barahona-Garrido, Sandra García-Osogobio, Gustavo López-Arce, Jesús Camacho-Escobedo, Angela Saúl, Salvador Herrera-Gómez, Javier Elizondo-Rivera, Rafael Barreto-Zúñiga
Clin Endosc 2014;47(1):79-83.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.79
AbstractAbstract PDFPubReaderePub
Background/Aims

No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination.

Methods

A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included.

Results

A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact.

Conclusions

Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

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Case Report
A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep
Jin-Seok Park, Byoung Wook Bang, Junyoung Shin, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin, Suk Jin Choi
Clin Endosc 2014;47(1):101-103.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.101
AbstractAbstract PDFPubReaderePub

Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.

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Review
Gastric Polyps and Protruding Type Gastric Cancer
Jin Tae Jung
Clin Endosc 2013;46(3):243-247.   Published online May 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.3.243
AbstractAbstract PDFPubReaderePub

Gastric protruding lesions are frequently encountered by health screening esophagogastroduodenoscopy. They can be classified into epithelial lesion and subepithelial lesion. Epithelial gastric lesions are generally divided into benign and malignant. Benign lesions include some types of polyps, i.e., hyperplastic polyp, fundic gland polyp, and gastric adenoma. Malignant lesions include carcinoid, early gastric cancer and advanced gastric cancer. They can be accurately diagnosed by magnifying endoscopy or narrow band imaging. Here, I will discuss benign and malignant epithelial lesions of the stomach.

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Case Report
A Case of Large Fibrovascular Polyp of the Stomach
Eun Ji Lee, Seung Goun Hong, Hae Ri Baek, Chan Bok Lee, Sang Myung Choi, Sung Jin Kim, Byoung Gy Chae, Cheul Young Choi
Clin Endosc 2013;46(2):186-188.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.186
AbstractAbstract PDFPubReaderePub

A fibrovascular polyp is a rare benign disease of the upper digestive tract and is usually located in the esophagus. To our knowledge, this is the first case of gastric fibrovascular polyp presenting with melena reported in the English literature. The polyp was well visualized on endoscopy and removed with laparoscopic wedge resection. Histology confirmed fibrovascular polyp of the stomach.

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Focused Review Series: Optical Diagnosis and New Management Strategys of Colorectal Polyps
Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging
Amit Rastogi
Clin Endosc 2013;46(2):120-129.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.120
AbstractAbstract PDFPubReaderePub

Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

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Introduction: What Are New Roles of Current Colonoscopy?
Hyung Wook Kim
Clin Endosc 2013;46(2):118-119.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.118
AbstractAbstract PDFPubReaderePub

The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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  • 40 Download
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