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Detection and Treatment of Early Flat and Depressed Colorectal Cancer Using High-Magnification Chromoscopic Colonoscopy: A Change in Paradigm for Western Endoscopists?

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Abstract

Japanese researchers reported flat and depressed colorectal lesions in the 1980s. Such lesions were thought irrelevant to Western populations and described as “Phantom” or “Akitas” carcinoma. Many depressed neoplasms arise through the de novo pathogenic sequence and demonstrate early invasive characteristics. All investigators report difficulties in identifying flat and depressed lesions using conventional colonoscopy. Failure to detect and treat such lesions may be responsible for the current shortfalls in secondary colorectal cancer prevention. Given the introduction of colorectal cancer screening programs in the United Kingdom, Europe, and the United States, it is essential to re-evaluate the significance of flat lesions as applicable to Western cohorts and explore the safety and efficacy of new endoscopic technology and interventional therapeutics.

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References

  1. Nishi M, Omori Y, Miwa K (1995) Japanese research society for gastric cancer, Japanese classification of gastric carcinoma. Kanehara, Tokyo

    Google Scholar 

  2. Anonymous (1986) Registration of cases of diagnosed cancer registered in England and Wales 1986. Office of population census and surveys. Cancer statistics, Series MBI, 19. HMSO, London 1983

  3. Mountney L, Sanderson H, Harris J (1994) Colorectal cancer. In Stevens A, Rafterty J (eds). Health care needs assessment. Radcliffe Medical Press, Oxford, p 1

    Google Scholar 

  4. World Health Organisation International Agency for Research on Cancer, European Commission (1996) Survival of cancer patients in Europe: the Eurocare study. International Agency for Research on Cancer Scientific Publications, Lyons.

  5. NHS Executive (1997) Guidance on commissioning cancer services. Improving outcomes in colorectal cancer. NHS Executive, Wetherby, UK

    Google Scholar 

  6. Moreaux J, Catala M (1987) Carcinoma of the colon: long-term survival and prognosis after surgical treatment in a series of 798 patients. World J Surg 11:804–809

    Article  PubMed  CAS  Google Scholar 

  7. Kudo S, Kashida H, Tamura T, Kogure E, Imai Y, Yamano H, Hart AR (2000) Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 24:1081–1090

    Article  PubMed  CAS  Google Scholar 

  8. Rembacken BJ, Gotoda T, Fujii T, Axon AT (2001) Endoscopic mucosal resection. Endoscopy 33:709–718

    Article  PubMed  CAS  Google Scholar 

  9. Morson B (1974) President’s address. The polyp-cancer sequence in the large bowel. Proc R Soc Med 67:451–457

    PubMed  CAS  Google Scholar 

  10. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981

    Article  PubMed  CAS  Google Scholar 

  11. Muller AD, Sonnenberg A (1995) Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med 123:904–910

    PubMed  CAS  Google Scholar 

  12. Atkin WS, Morson BC, Cuzick J (1992) Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 326:658–662

    Article  PubMed  CAS  Google Scholar 

  13. Hurlstone DP, Fujii T, Lobo AJ (2002) Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy. Br J Surg 89:272–282

    Article  PubMed  CAS  Google Scholar 

  14. Hurlstone DP, Karajeh MA, Shorthouse AJ (2004) Screening for colorectal cancer: implications for UK and European initiatives. Tech Coloproctol 8:139–145

    Article  PubMed  CAS  Google Scholar 

  15. Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2003) A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the UK. Am J Gastroenterol 98:2543–2549

    Article  PubMed  Google Scholar 

  16. Rembacken BJ, Fujii T, Cairns A, Dixon MF, Yoshida S, Chalmers DM, Axon AT (2000) Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 355:1211–1214

    Article  PubMed  CAS  Google Scholar 

  17. Saito Y, Waxman I, West AB, Popnikolov NK, Gatalica Z, Watari J, Obara T, Kohgo Y, Pasricha PJ (2001) Prevalence and distinctive biological features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657–1665

    Article  Google Scholar 

  18. Wolber RA, Owen DA (1991) Flat adenoma of the colon. Hum Pathol 22:70–74

    Article  PubMed  CAS  Google Scholar 

  19. Willis J, Riddell RH (2003) Biology versus terminology: East meets West in surgical pathology. Gastrointest Endosc 57:369–376

    Article  PubMed  Google Scholar 

  20. Kudo S, Hayashi S, Miura K, Takano M, Saito M, Kubuta Y (1989) The clinicopathological features of flat and depressed type of early colorectal cancer [in Japanese with English abstract]. Stomach Intestine 24:317–329

    Google Scholar 

  21. Matsumoto T, Iida M, Yao T, Fujishima M (1994) Role of nonpolypoid neoplastic lesions in the pathogenesis of colorectal cancer. Dis Colon Rectum 37:450–455

    Article  PubMed  CAS  Google Scholar 

  22. Hurlstone DP, Karajeh M, Sanders DS, Drew SK, Cross SS (2005) Rectal aberrant crypt foci identified using high-magnification-chromoscopic colonoscopy: biomarkers for flat and depressed neoplasia. Am J Gastroenterol 100:1283–1289

    Article  PubMed  Google Scholar 

  23. Hurlstone DP, Cross SS (2005) Role of aberrant crypt foci detected using high-magnification chromoscopic colonoscopy in human colorectal carcinogenesis. J Gastroenterol Hepatol 20:173–181

    Article  PubMed  Google Scholar 

  24. Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S (2004) Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut 53:376–380

    Article  PubMed  CAS  Google Scholar 

  25. Hurlstone DP, Karajeh M, Cross SS, McAlindon ME, Brown S, Hunter MD, Sanders DS (2005) The role of high-magnification-chromoscopic-colonoscopy in hereditary nonpolyposis colorectal cancer screening: a prospective ‘back-to-back’ endoscopic study. Am J Gastroenterol 100:2167–2173

    Article  PubMed  Google Scholar 

  26. Tung SY, Wu CS, Su MY (2001) Magnifying colonoscopy in differentiating neoplastic from nonneoplastic colorectal lesions. Am J Gastroenterol 96:2628–2632

    Article  PubMed  CAS  Google Scholar 

  27. Togashi K, Konishi F, Ishizuka T, Sato T, Senba S, Kanazawa K (1999) Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel. Dis Colon Rectum 42:1602−1608

    Article  PubMed  CAS  Google Scholar 

  28. Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290

    Article  PubMed  CAS  Google Scholar 

  29. Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies. Endoscopy 36:491–498

    Article  PubMed  CAS  Google Scholar 

  30. Hurlstone DP, Sanders DS, Cross SS, Adam I, Shorthouse AJ, Brown S, Drew K, Lobo AJ (2004) Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut 53:1334–1339

    Article  PubMed  CAS  Google Scholar 

  31. Hurlstone DP, Sanders DS, Cross SS, George R, Shorthouse AJ, Brown S (2005) A prospective analysis of extended endoscopic mucosal resection for large rectal villous adenomas: an alternative technique to transanal endoscopic microsurgery. Colorectal Dis 7:339–344

    Article  PubMed  CAS  Google Scholar 

  32. Okamoto H, Tanaka S, Haruma K (1996) Japanese review of complications and measure by endoscopic treatment for colorectal tumor between 1989−1993 [in Japanese with English abstract]. Hiroshimaigaku 49:585–591

    Google Scholar 

  33. Kaneko E, Harada H, Kasugai T, Sakita T (1995) The results of a multi-centre analysis from 1988–1992. Gastroenterol Endosc 37:642–652

    Google Scholar 

  34. Hurlstone DP, Brown S, Cross SS, Shorthouse AJ, Sanders DS (2005) High magnification chromoscopic colonoscopy or high frequency 20 MHz mini probe endoscopic ultrasound staging for early colorectal neoplasia: a comparative prospective analysis. Gut 54:1585–1589

    Article  PubMed  CAS  Google Scholar 

  35. Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Endoscopic morphological anticipation of submucosal invasion in flat and depressed colorectal lesions: clinical implications and subtype analysis of the Kudo type V pit pattern using high-magnification-chromoscopic colonoscopy. Colorectal Dis 6:369–375

    Article  PubMed  CAS  Google Scholar 

  36. Hurlstone DP, Brown S, Cross SS, Shorthouse AJ, Sanders DS (2005) Endoscopic ultrasound miniprobe staging of colorectal cancer: can management be modified? Endoscopy 37:710–714

    Article  PubMed  CAS  Google Scholar 

  37. Medical Examinations for Digestive Cancer in 1995 Group (1998) National Report. J Gastroenterol Mass 130:251–269

  38. Shida H, Ban K, Matsumoto M, Masuda K, Imanari T, Machida T, Yamamoto T, Inoue T (1996) Asymptomatic colorectal cancer detected by screening. Dis Colon Rectum 39:1130–1135

    Article  PubMed  CAS  Google Scholar 

  39. Kitamura K, Taniguchi H, Yamaguchi T, Sawai K, Takahashi T (1997) Clinical outcome of surgical treatment for invasive early colorectal cancer in Japan. Hepatogastroenterology 44:108–115

    PubMed  CAS  Google Scholar 

  40. Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB (2002) Treatment with argon plasma coagulation reduces recurrence after piecmeal resection of large sessile colonic polyps: a randomised trial and recommendations. Gastrointest Endosc 55:371–375

    Article  PubMed  Google Scholar 

  41. Hurlstone DP, Cross SS, Brown S, Sanders DS, Lobo AJ (2004) A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR. Gastrointest Endosc 59:642–650

    Article  PubMed  Google Scholar 

  42. Brostrom MO, Lofberg R, Ost A (1986) Cancer surveillance of patients with longstanding ulcerative colitis: A clinical and endoscopical and histological study. Gut 27:1408–1413

    PubMed  CAS  Google Scholar 

  43. Goldmann H (1996) Significance and detection of dysplasia in chronic colitis. Cancer 78:2261–2263

    Article  Google Scholar 

  44. Riddell RH, Goldman H, Ransohoff DF, Appelman HD, Fenoglio C, Haggit RC, Ahren C, Correa P, Hamilton SR, Morson BC (1983) Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical implications. Hum Pathol 14:931–968

    Article  PubMed  CAS  Google Scholar 

  45. Hurlstone DP, Sanders DS, Lobo AJ, McAlindon ME, Cross SS (2005) Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy 37:1186–1192

    Article  PubMed  CAS  Google Scholar 

  46. Hurlstone DP, McAlindon ME, Sanders DS, Koegh R, Lobo AJ, Cross SS (2004) Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 126:376–378

    Article  PubMed  Google Scholar 

  47. Kiesslich R, Fritsch J, Holtmann M, Koehler HH, Stolte M, Kanzler S, Nafe B, Jung M, Galle PR, Neurath MF (2003) Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 124:880–888

    Article  PubMed  Google Scholar 

  48. Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC (2004) Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 53:256–260

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endoscopy, Royal Hallamshire Hospital, 17 Alexandra Gardens, Lyndhurst Road, Nether Edge, Sheffield, S11 9DQ, United Kingdom

    David Paul Hurlstone & David S. Sanders

  2. Department of Endoscopy, Sheffield Childrens Hospital, Sheffield, United Kingdom

    Mike Thomson

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  1. David Paul Hurlstone
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  2. David S. Sanders
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  3. Mike Thomson
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Correspondence to David Paul Hurlstone.

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Hurlstone, D.P., Sanders, D.S. & Thomson, M. Detection and Treatment of Early Flat and Depressed Colorectal Cancer Using High-Magnification Chromoscopic Colonoscopy: A Change in Paradigm for Western Endoscopists?. Dig Dis Sci 52, 1387–1393 (2007). https://doi.org/10.1007/s10620-006-9460-2

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