Colorectum: Mucosal neoplasias

To minimize the risk for interval cancer after colonoscopy, we aim to improve detection of small (<10 mm) and minute (<5 mm) flat-type neoplasias and often inconspicuous lateral spreading tumors in the colon. You need to distinguish neoplastic lesions differing in malignant potential and rate of progression in order to stratify surveillance intervals for follow-up. We focus on image-enhanced endoscopic distinction of (a) nonneoplastic lesions versus neoplasias and (b) intramucosal or superficial submucosa-invasive (sm1) neoplasias versus deep submucosa-invasive (sm2-3) early cancer. Endoscopic criteria allow defining (a) the lateral margins of flat neoplasias and (b) the likely grade of invasion-both required to decide indications for endoscopic en bloc resection or resective surgery.