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News

European guidelines on the advanced imaging for detection of colorectal cancer

This month's Endoscopy reports on the European Society of Gastrointestinal Endoscopy Guideline on advanced imaging for detection and differentiation of colorectal neoplasia.

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Dr Michal Kaminski and colleagues report on the guidelines, and official statement of the European Society of Gastrointestinal Endoscopy (ESGE).

The guidelines address the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia.

The team report several main recommendations.

The first recommendations suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations.

Secondly, the ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual chromoendoscopy in patients with known or suspected Lynch syndrome.

The ESGE recommends the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations
Alimentary Pharmacology & Therapeutics

The ESGE also recommends the routine use of high definition systems and pancolonic conventional or virtual chromoendoscopy in patients with known or suspected serrated polyposis syndrome.

The ESGE encourages the routine use of 0.1 % methylene blue or 0.1 %  0.5 % indigo carmine pancolonic chromoendoscopy with targeted biopsies for neoplasia surveillance in patients with long-standing colitis.

The team noted that in appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, 4-quadrant biopsies can be abandoned.

In addition, the ESGE suggests that virtual chromoendoscopy and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive colorectal polyps to replace histopathological diagnosis.

The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained and audited.

The ESGE also suggests the use of conventional or virtual magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component or nongranular or mixed-type laterally spreading tumors.

Dr Kaminski and team conclude, "Advanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs."

Endoscopy 2014; 46(05): 435-457
09 May 2014

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