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Background and Aims: Traditionally large, complex colorectal polyps were managed by surgical resection (SR), and in recent years endoscopic resection (ER) has progressed significantly. However, to what extent ER has replaced SR remains largely unknown. We performed a multicenter retrospective cohort study to assess the volume and volume changes of SR for benign colorectal polyps over the past decade. Methods: Patients who underwent SR for a benign colorectal polyp in the Netherlands between 2005 and 2015 were selected from the prospective nationwide Dutch Pathology Registry (PALGA database). Clinical characteristics were obtained from the charts of patients who underwent SR in the province of Noord-Holland. Results: A total of 5937 patients were treated with SR for a colorectal polyp and the absolute (454-739 per year) and relative volumes (0.20%-0.37% per colonoscopy per year) of SR remained stable. In the province of Noord-Holland, 928 patients (15.6%) underwent SR. In these patients, submucosal lifting and ER were attempted in 19.9% (n = 175) and 15.0% (n = 134). After 2010, patients were more likely to undergo lifting (27.7% vs 11.4%, P

Background and study aims: Endoscopic optical diagnosis can potentially replace histopathological evaluation of small colorectal lesions. The aim of this study was to evaluate diagnostic performance of WavSTAT, a novel system for automatic optical diagnosis based on laser-induced autofluorescence spectroscopy. Patients and methods: Consecutive patients who were scheduled for colonoscopy were included in the study. Each detected lesion with a size of ≤ 9 mm was differentiated using high resolution endoscopy (HRE) by the endoscopist, who then reported this as a low or high confidence call. Thereafter, all lesions were analyzed using WavSTAT. Histopathology was used as the reference standard. The primary outcome measures were the accuracy of WavSTAT to differentiate between adenomatous and nonadenomatous lesions, and the accuracy of an algorithm combining HRE (lesions differentiated with high confidence) and WavSTAT (all remaining lesions). The secondary outcome measure was the accuracy of on-site recommended surveillance intervals. Results: At total of 87 patients with 207 small colorectal lesions were evaluated. Accuracy and negative predictive value of WavSTAT were 74.4 % and 73.5 %, respectively. The corresponding figures for the algorithm were 79.2 % and 73.9 %, respectively. Accuracy of on-site recommended surveillance interval was 73.7 % for WavSTAT alone and 77.2 % for the algorithm of HRE and WavSTAT. Conclusions: Both accuracy of WavSTAT alone and the algorithm combining HRE with WavSTAT proved to be insufficient for the in vivo differentiation of small colorectal lesions, and do not fulfill American Society for Gastrointestinal Endoscopy performance thresholds for assessment of diminutive lesions. Future studies should assess whether combining WavSTAT with more advanced imaging techniques could result in a higher accuracy. Netherlands Trial Registry (NTR 3235).

However, limited data are available on the validity of endocytoscopy in the diagnosis of gastric disorders. The aim of this prospective study was to evaluate the feasibility of endocytoscopy in the diagnosis of early gastric cancer. Methods: Patients who planned to undergo magnifying endoscopic work-up before or after gastric ESD were eligible. Examination was done with a single CCD integrated endocytoscope. Patients who had gastric lesions that required histopathological diagnosis with biopsy specimen were enrolled and evaluated by endocytoscopy with a double staining of 0.05% crystal violet and 0.1% methylene blue. Endocytoscopic atypia of gland structure was assessed. Structural atypia was defined by the presence of three morphological abnormalities; absence or narrowing of inter-glandular space, glandular fusion and glandular destruction. Endocytoscopic atypia were graded as none, low and high. The primary endpoint was the accuracy of endocytoscopic diagnosis for gastric cancer using histopathological diagnosis of biopsy specimens as the gold standard. Results: 1) Eighty-two lesions in 54 patients were enrolled; 23 early gastric cancers (21 well differentiated type, 2 poorly differentiated type), 10 gastric adenomas, 10 gastric ulcers, 10 gastric erosions, 18 gastric protruded lesions. Eleven points of gastric mucosa surrounding gastric neoplasia were also examined to evaluate neoplasia extent for precise endoscopic resection. 2) Ten lesions could not be well observed by endocytoscopy because of poor staining due to viscous mucus or dense ulcer plaque. The assessable rates with endocytoscopy were 88% (72/ 82) in total and 91% (21/23) in gastric cancer, whereas it was 78% in gastric protruded lesions, especially was low at 50% in hyperplastic polyps.3) High grade of endocytoscopic atypia was observed in 86% of assessable gastric cancers (n 21), whereas high grade of endocytoscopic atypia was not observed in assessable lesions of gastric adenomas and other nonneoplastic lesions. Low grade of endocytoscopic atypia was observed in 78% of assessable gastric adenomas (n 9), 9% of gastric cancer, and 2.3% of nonneoplastic lesions. Using the criterion of high grade-endocytoscopic atypia, sensitivity, specificity, PPV and NPV of endocytoscopic diagnosis for gastric cancer were 86%, 100%, 100% and 94%, respectively. 4) No serious complication occurred during and after the examinations. Conclusion: Endocytoscopy is a clinically feasible modality to obtain in vivo histology with high diagnostic accuracy in gastric cancer.