Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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The Past, Present and Future of Imaging Enhanced Endoscopy in Colon Tumor

대장 종양에서의 영상 증강 내시경 이용의 과거와 현재, 미래

  • Kyueng-Whan Min (Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University) ;
  • One-Zoong Kim (Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University)
  • 민경환 (을지대학교 의과대학 병리학교실) ;
  • 김원중 (을지대학교 의과대학 내과학교실)
  • Received : 2024.07.15
  • Accepted : 2024.08.05
  • Published : 2024.08.20
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Abstract

The incidence of colon cancer in South Korea has recently been the highest among gastrointestinal cancers. Early diagnosis is critical, and image-enhanced endoscopy (IEE) is a key diagnostic method. Colon tumors primarily include serrated polyps, adenomatous polyps, and colon cancer. Early endoscopic techniques relied on simple visual inspection for diagnosis, with tumor size and shape being the primary considerations. Low-resolution images made these methods ineffective for detecting small or early-stage lesions. IEE now enables detailed examination using high-resolution images and various color and structure analyses. Techniques like narrow band imaging (NBI) allow precise observation of vascular patterns and surface structures. Hyperplastic polyps often appear similar in color to the surrounding mucosa, with no visible vascular pattern. Sessile serrated lesions have a cloudy surface with distinct boundaries and irregular patterns, often with black spots in the crypts. Adenomatous polyps are darker brown, with a visible white epithelial network and various pit patterns. Magnified images help differentiate between low- and high-grade dysplasia, with low-grade showing regular patterns and high-grade showing increased irregularities. The NBI International Colorectal Endoscopic classification identifies malignant colon tumors as brown or dark brown with disorganized vascular patterns. The Japan NBI Expert Team classification includes loose vascular areas and disrupted thick vessels. The Workgroup serrAted polypS and Polyposis classification aids in differentiating between hyperplastic polyps and sessile serrated lesions/adenomas when deciding whether to resect polyps larger than 5 mm. Suspected high-grade dysplasia warrants endoscopic submucosal dissection and follow-up. Future advancements in IEE are expected to further enhance early detection and diagnostic accuracy.

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