Value of Endoscopic Diagnosis and Resection Techniques for Detection and Therapy of Benign and Malign Colorectal Neoplasias

Diagnosis and therapy of benign and malign colorectal neoplasias are based on morphological and histopathological classifications (Paris-Classification, Kyoto-Conference). In principle polyps are, according to their appearance, divided in protruding (0-I), flat (0-II) and ulcerated (0-III) forms. Flat polyps account for about one-third of the entirety of all colorectal polyps. Overall frequency of malign degeneration of colorectal polyps positively correlates with polyp size. In this context 0-IIc lesions are an exception: already 0-IIc lesions <1 cm show considerable increased carcinoma rates, are no longer early invasive and should be transferred for oncological resection. This applies for a lower extent also to LST-NG-polyps. Early colorectal cancer is defined by sole and exclusively invasion of the submucosal layer. Therapy of early colorectal cancer is based on low-risk-/high-risk-concept. This concept includes tumor-grading, lymphangioinvasion, tumorcell-budding and depth of submucosal invasion. According to the depth of submcosal invasion stages are divided in sm1-, sm2- and sm3-invasion respectively. Alternatively for polypectomy specimen measurement of submucosal invasion depth is used and the maximal acceptable extent is assessed to 1000 mu m (does not apply to pedunculated polyps!). Low-risk-early-cancers show low rates of lymphnode metastasis (0+/-2 %). Hence for proven complete resection (R0-status), local endoscopic therapy is sufficient and subsequent oncological resection is needless. Generally benign neoplasias are safely and effectively treatable by endoscopy regardless to their size. Long-term-results of endoscopic treatment are satisfactory. ESD is indicated if en-bloc-resection is intended (i.e. for "advanced" histology) and the polypoid lesion is located in the rectum below the peritoneal fold.