Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal...

Area of Science:

• Gastroenterology
• Endoscopic Imaging
• Oncology

Background:

• Piecemeal endoscopic mucosal resection (EMR) is limited by inaccurate histological assessment of resected specimens, particularly for submucosal invasion.
• Accurate pre-procedural classification of lesions is crucial for selecting appropriate EMR candidates.

Purpose of the Study:

• To classify non-pedunculated lesions ≥20 mm based on endoscopic morphology.
• To identify lesions with intramucosal neoplasia suitable for piecemeal EMR.

Main Methods:

• Post-hoc analysis of a prospective multicentre study involving 58 endoscopists.
• Conditional inference trees (CTREE) were used to analyze the association between intramucosal neoplasia and endoscopic characteristics.
• White light imaging and narrow-band imaging (NBI) were utilized.

Main Results:

• Intramucosal neoplasia was present in 89.3% of 542 analyzed lesions.
• Ulceration, pseudodepressed type, and sessile morphology significantly impacted the prediction accuracy of intramucosal neoplasia.
• Non-ulcerated LST-G and LST-NG flat elevated lesions showed a high probability (96.2%) of intramucosal neoplasia.

Conclusions:

• Non-ulcerated LST-G and LST-NG flat elevated lesions are common and highly likely to harbor intramucosal neoplasia, making them suitable for piecemeal EMR.
• For other lesion types, advanced techniques like magnification or endoscopic submucosal dissection may be necessary.
• Endoscopic morphological classification aids in selecting patients for piecemeal EMR, improving procedural outcomes.