Associate Editor, Dr. Lisa Strate, highlights this article from the August issue “The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management” by Douglas K. Rex, MD, Cesare Hassan, MD, and Michael J. Bourke, MD

This is a wonderfully comprehensive yet concise guide to the vocabulary regarding colonoscopy with polypectomy and its clinical implications.

The field of colonoscopy is always moving forward, and it is important for practicing gastroenterologists to stay up-to-date since nearly all perform screening and surveillance colonoscopies. Understanding histology and morphology are an essential aspect of high-quality colonoscopy. In this article, important pathologic and morphologic concepts are outlined as well as optimal management strategies. This article contains excellent tables on narrow-band imaging classification of polyps, granular vs non-granular laterally spreading tumors, and colorectal neoplasia according to lesion type, shape, distribution, and pathology paired. Representative endoscopic and histologic images are also included.

Endoscopists performing adult colonoscopy should understand histologic and morphologic terms regarding colon polyps. Understanding these terms will optimize the management and follow-up of patients with colorectal neoplasia.

Figure 1. Lesions with NICE type 3 features indicating deep submucosal invasion. In A, much of the lesion shows type 3 features with a disrupted amorphous blood vessel pattern. The yellow line overlies one of the areas of NICE type 2 features, indicating residual intact adenoma. In B, most of the lesion has NICE type 2 features but the area surrounded by the yellow line has a disrupted vascular pattern consistent with NICE type 3 and indicative of deep submucosal invasion.

Read the article abstract here.

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