Lafeuille Pierre, Daire Emilien, Rivory Jérôme, Rostain Florian, Saurin Jean-Christophe, Lambin Thomas, Moll Frédéric, Subtil Fabien, Fenouil Tanguy, Jacques Jérémie, Pioche Mathieu
Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, 69437, Lyon, France.
Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.
Surg Endosc. 2025 Mar;39(3):1622-1634. doi: 10.1007/s00464-024-11501-7. Epub 2025 Jan 8.
Accurate endoscopic characterization of colorectal lesions is essential to predict histology and select the best treatment strategy but remains very difficult. Instead of the recommended endoscopic characterization, many gastroenterologists routinely perform biopsies of the lesion to propose endoscopic resection with or without R0 intent. The aim of this study was to determine which of endoscopic characterization or biopsies, either targeted (TB) or non-targeted (NTB), is the most effective to determine the best treatment strategy for colorectal neoplasia > 2 cm.
We prospectively assessed the best strategy between endoscopic characterization and targeted or non-targeted biopsies, so that the proposed resection technique offered a level of quality of tumor resection adapted to the definitive histology of the lesion on R0-resected specimen.
84 patients with 88 lesions were included. "Adequate treatment" was proposed by endoscopic characterization in 52.3 to 70.5% of cases, "under treatment" in 2.3 to 9.1% and "over treatment" in 20.5 to 45.5%. Two severe events were recorded. "Adequate treatment" was proposed by TB and NTB in respectively 72.7 and 69.3% of cases, "under treatment" in respectively 27.3 and 30.7% and no case of "over treatment" was reported. TB and NTB were ineffective to evaluate the depth of invasion in the submucosa and to differentiate superficial invasive from deep invasive adenocarcinomas.
Biopsies-based strategies are unable to predict depth of cancer invasion and could be associated with a risk of under treatment of large colorectal lesions in near a third of the cases compared to only around 5% with endoscopic characterization. Endoscopic characterization could lead to over treatment, but mainly by endoscopic submucosal dissection with low morbidity. Characterization with the CONECCT classification could decrease the risk of under treatment and avoid surgeries for non-malignant colorectal lesions. Other endoscopic criteria should be determined to better characterize colorectal lesions and to improve the best adapted treatment for each lesion.
准确的结直肠病变内镜特征对于预测组织学类型和选择最佳治疗策略至关重要，但仍然非常困难。许多胃肠病学家不采用推荐的内镜特征描述，而是常规对病变进行活检，以决定是否进行有或无R0切除意图的内镜切除。本研究的目的是确定内镜特征描述与靶向活检（TB）或非靶向活检（NTB）中哪一种对于确定直径大于2 cm的结直肠肿瘤的最佳治疗策略最有效。
我们前瞻性地评估了内镜特征描述与靶向或非靶向活检之间的最佳策略，以便所建议的切除技术能够提供与R0切除标本上病变的最终组织学相适应的肿瘤切除质量水平。
纳入了84例患者的88个病变。通过内镜特征描述，52.3%至70.5%的病例提出了“适当治疗”，2.3%至9.1%的病例为“治疗不足”，20.5%至45.5%的病例为“过度治疗”。记录了两起严重事件。TB和NTB分别在72.7%和69.3%的病例中提出了“适当治疗”，分别在27.3%和30.7%的病例中为“治疗不足”，未报告“过度治疗”病例。TB和NTB在评估黏膜下层浸润深度以及区分浅表浸润性和深部浸润性腺癌方面无效。
基于活检的策略无法预测癌症浸润深度，与大约三分之一的大的结直肠病变治疗不足风险相关，而内镜特征描述的这一风险仅约为5%。内镜特征描述可能导致过度治疗，但主要是通过内镜黏膜下剥离术，其发病率较低。采用CONECCT分类进行特征描述可降低治疗不足的风险，并避免对非恶性结直肠病变进行手术。应确定其他内镜标准，以更好地描述结直肠病变特征，并为每个病变改进最佳适配治疗。
