Endoscopy 2014; 46(05): 435-457
DOI: 10.1055/s-0034-1365348
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Michał F. Kamiński
1  Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
,
Cesare Hassan
2  Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Raf Bisschops
3  Department of Gastroenterology, University Hospital Leuven, Leuven, Belgium
,
Jürgen Pohl
4  Department of Gastroenterology and Interventional Endoscopy, Klinikum im Friedrichshain, Berlin, Germany
,
Maria Pellisé
5  Department of Gastroenterology, Institut de Malaties Digestives i Metabòliques, Hospital Clinic, Barcelona, Spain
,
Evelien Dekker
6  Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
,
Ana Ignjatovic-Wilson
7  Wolfson Unit for Endoscopy, St Mark's Hospital, Imperial College London, UK
,
Arthur Hoffman
8  Medizinische Klinik, St. Mary Hospital, Frankfurt, Germany
,
Gaius Longcroft-Wheaton
9  Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
,
Denis Heresbach
10  Department of Gastroenterology, University Hospital, CHU Rennes, France
,
Jean-Marc Dumonceau
11  Gedyt Endoscopy Center, Buenos Aires, Argentina
,
James E. East
12  Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom.
› Author Affiliations
Further Information

Publication History

Publication Date:
17 March 2014 (online)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia.

Main recommendations

1 ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence).

2 ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (narrow band imaging [NBI], i-SCAN) chromoendoscopy in patients with known or suspected Lynch syndrome (strong recommendation, low quality evidence).

2b ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (NBI) chromoendoscopy in patients with known or suspected serrated polyposis syndrome (strong recommendation, low quality evidence).

3 ESGE recommends 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. In appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, four-quadrant biopsies can be abandoned (strong recommendation, high quality evidence).

4 ESGE suggests that virtual chromoendoscopy (NBI, FICE, i-SCAN) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) 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 (weak recommendation, high quality evidence).

5 ESGE suggests the use of conventional or virtual (NBI) magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component (0-IIc according to the Paris classification) or nongranular or mixed-type laterally spreading tumors (weak recommendation, moderate quality evidence).

Conclusion

Advanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs.

Appendix e1 – e8