Masterclass: Advanced GI Endoscopic Imaging (On-Demand) | December 2025-Bechara - Resection Decisions Based on Lesion Characteristics-short Qaulity

Bechara - Resection Decisions Based on Lesion Characteristics-short Qaulity

Pdf Summary

This presentation by Dr. Robert Bechara discusses resection decisions in colonoscopy based on lesion characteristics, emphasizing the importance of diagnostic quality indicators to improve colorectal cancer (CRC) prevention outcomes. Updated 2024 ASGE/ACG guidelines highlight five core measurable and evidence-based colonoscopy quality metrics: bowel preparation adequacy (≥90% with BBPS score ≥2 per segment), withdrawal time (average 8 minutes in normal cases), cecal intubation rate (≥95%), adenoma detection rate (ADR) minimum overall 35%—40% in males and 30% in females—and sessile serrated lesion detection rate (SSLDR) of 6%.<br /><br />The presentation includes multiple colonoscopy case studies illustrating lesion classification and corresponding pathology. Lesions are categorized using JNET classifications—ranging from JNET 1 (sessile serrated lesion) to JNET 3 (deeply invasive cancer)—and lateral spreading tumor (LST) morphology types, such as homogeneous or mixed granular (LST-G) and non-granular flat or pseudo-depressed types (LST-NG-F, LST-NG-PD).<br /><br />Case #2 and Case #1 involved minimally invasive adenocarcinomas arising from tubulovillous adenomas with high-grade dysplasia (HGD), featuring submucosal invasion of 0.2 mm (pT1), with no lymphovascular or perineural invasion and clear margins, indicating appropriate resection decision-making based on lesion characteristics.<br /><br />Overall, Dr. Bechara underscores how lesion morphology, JNET classification, and pathology guide therapeutic decisions during advanced endoscopic procedures, aiming to optimize outcomes while preventing CRC progression. The presentation reinforces adherence to quality benchmarks in colonoscopy to maximize diagnostic accuracy and patient benefit.<br /><br />Contact: Robert.Bechara@kingstonhsc.ca | Twitter: @RobertBechara | YouTube: /rbendoscopy

Keywords

colonoscopy

colorectal cancer prevention

ASGE/ACG guidelines

bowel preparation adequacy

adenoma detection rate

sessile serrated lesion detection rate

JNET classification

lateral spreading tumor morphology

high-grade dysplasia

endoscopic resection decision-making