ASGE International Sampler (On-Demand) | 2024-Lesion assessment colonoscopy: Translating lesion assessment into resection decisions

Lesion assessment colonoscopy: Translating lesion assessment into resection decisions

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The document discusses lesion assessment in colonoscopy and its translation into resection decisions. The author emphasizes the importance of complete, safe, and efficient removal of lesions in a single session, as well as the need for real-time histologic assessment. High-quality imaging and the use of optical diagnosis classifications are recommended. The document also highlights the signatures of adenoma, including subtle color differential, irregular vascular network, absence of innominate grooves, slight friability, and wall deformity. The concept of detection and diagnosis is presented, along with the optimization of basics such as iris setting and processor setting.<br /><br />The document includes the validation of the "valley sign" as a marker for conventional adenomas. The prevalence of the valley sign in small adenomas is described, and its specificity is discussed. The document also mentions the features of deep submucosal invasion that indicate an endoscopically unresectable lesion, such as redness, firm consistency, expansion, fold convergency, deep depressed area, and white spots.<br /><br />Different techniques for endoscopic resection, such as the inject and cut EMR technique and dynamic submucosal injection technique, are explained. The document emphasizes the importance of optimizing the position, using a stiff snare with a healthy margin, and assessing post-resection margins.<br /><br />The document concludes with take-home points, which include the characterization of lesion size, morphology, and predicted histology in real-time, choosing appropriate strategies for safe and complete resection, and being intentional in decision-making. The contact information of the author is also provided.

Keywords

lesion assessment

colonoscopy

resection decisions

real-time histologic assessment

optical diagnosis

adenoma signatures

valley sign

endoscopic resection

inject and cut EMR

dynamic submucosal injection