Therapeutic endoscopy in the flat and depressed colorectal lesions after evaluation with flexible spectral imaging color enhancement and high-frequency endoscopic ultrasonography

BACKGROUND: In this study is evaluated the role of Endoscopic Mucose Resectin (EMR) in the treatment of flat lesions and sessile colorectal cancer, diagnosed during colonoscopy and evaluated with Flexible Spectral Imaging Color Enhancement (FICE) and High-frequency Endoscopic Ultrasonography (HFEUS), to determine the invasiveness degree of the colon wall. Colorectal polypoid lesions are not always identified during a colonoscopy. The complete endoscopic resection of intramucosal carcinoma is accepted as curative, when there is a low degree of invasion of the submucosal layer, so evaluation of the infiltration depth submucosa is crucial. For this purpose we used the FICE and HFEUS.METHODS: Forty-seven patients (27 males, 20 females) with lesions of the colorectal polypoid were included in the study. The localization of the tumor, the shape, the size and penetration have been determined by endoscopy and endoscopic ultrasound, before performing a mucosectomy intervention.RESULTS: The comparison between FICE and HFEUS magnification revealed significant differences in the sensitivity, specificity, positive predictive value and negative predictive value between the two techniques. Mucosectomy was performed successfully in 45 patients, it was not able to proceed in 2 patients endoscopically, for failure to lift, and were subjected to surgical resection, revealing adenocarcinoma T2 in both cases. There was a complication with bleeding endoscopically treated.CONCLUSIONS: Non-polypoid colorectal lesions and cancers at an early stage can be treated with endoscopic resection. The colonic adenomas are considered as precursors of most colorectal cancers. Certainly early diagnosis and endoscopic treatment can reduce mortality from colorectal cancer. The most used techniques include endoscopic polypectomy for resection of the polypoid lesions and the EMR (EMR) for the treatment of sessile lesions. EMR is a safe procedure for the treatment of carcinomas in situ too. Many authors have demonstrated the effective implementation of the EMR technique in colorectal cancers with results comparable to surgical procedures. In this study we assessed the usefulness of EMR for the treatment of neoplastic colorectal flat and sessile, evaluated for the degree of invasion of the wall with FICE and HFEUS.