Post written by Yurie Kawabata, MD, from Digestive Disease Center, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan.
Our study focuses on evaluating whether assessing lesion-border findings (“distinct” vs “indistinct” borders) using indigo carmine chromoendoscopy can help identify cases in which Kudo’s pit pattern analysis is truly reliable for predicting the invasion depth of lesions in patients with ulcerative colitis (UC).
Differentiating intramucosal neoplasia from invasive cancer in UC patients is notoriously challenging. Because of chronic inflammation and a unique “bottom-up” tumor growth pattern, structural changes are often not readily visible on the surface. As a result, standard surface evaluations such as pit pattern analysis can be difficult to apply, potentially leading to inaccurate depth diagnoses, positive resection margins, or adverse events such as perforation during endoscopic resection. We felt it was crucial to establish a simple standardized triage method before proceeding with treatment.
To our knowledge, this is the first study to demonstrate the clinical impact of combining lesion-border findings with pit patterns for differentiating invasive from noninvasive neoplastic lesions in UC patients. We discovered that 100% of lesions presenting with a distinct border combined with a type II or IIIL pit pattern were strictly intramucosal. This specific combination provides an absolute indication for EMR or polypectomy. Conversely, pit pattern analysis proved to have limited use for lesions with indistinct borders, as submucosal invasive carcinomas were present even when type II or IIIL pit patterns were observed.
By simply assessing the lesion border first, endoscopists can accurately identify which lesions are safe for standard endoscopic resection and which require further evaluation or advanced techniques such as endoscopic submucosal dissection. As a next step, we are planning a multicenter, large-scale prospective study to validate these findings and firmly establish this strategy in clinical practice.
We hope this proposed algorithm empowers endoscopists worldwide to make safer, more confident treatment decisions for patients with UC, ultimately reducing the need for unnecessary total colectomies.
Proposed treatment strategy determined on the basis of the results of this study. EMR or polypectomy should be considered primarily for border-distinct lesions with a type II or IIIL pit pattern, whereas other lesions should be evaluated carefully to determine the optimal treatment strategy.
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