| International Session (Workshop) 1 (JGES・JSGE) |
| Sat. November 3rd 9:00 - 12:00 Room 13: Kobe International Conference Center International Conference Room |
| International evaluation of endoscopic classification - JNET | |||
| Evelien Dekker | |||
| Department of Gastroenterology & Hepatology, Academic Medical Center | |||
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| Due to the worldwide implementation of nationwide bowel cancer screening programs, endoscopic recognition and optimal treatment of early stage colorectal cancer (CRC) is becoming increasingly important. Patients with T1 cancers with favorable histological characteristics are at low risk for lymph node metastasis (6-27%). Hence, the majority of these lesions can be cured with local treatment such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) or transanal endoscopic microsurgery (TEM). Several histological characteristics predict the risk of lymph node metastases including the resection margin, depth of invasion, tumor grade, and presence or absence of lymphovascular invasion and tumor budding. However, these risk factors can only be assessed when the lesion is resected en bloc. Hence, if a T1 cancer is suspected during endoscopy, piecemeal resection should be avoided and en-bloc resection performed. Furthermore, accurate prediction of the depth of invasion should help the endoscopist to identify those lesions not amenable for endoscopic treatment, and these patients should be directly referred for surgery. High-quality endoscopic imaging and NBI facilitate accurate optical diagnosis. Several magnifying NBI classifications of colorectal tumors have been proposed and validated in Japan. The Japan NBI Expert Team has created a classification to assess the depth of invasion of colorectal lesions: the JNET-classification. In a web-based study, consensus was reached among Japanese endoscopists. In the Western world, this area of expertise is still developing. It has become clear that endoscopic recognition of early cancers falls short, and more accurate assessment of large and/or suspect lesions to assess the depth of invasion is warranted. High quality scopes are available as well a digital chromoendoscopy with NBI, BLI and comparable techniques are widely spread, but when imaging a colorectal lesion, zoom and near-focus imaging are not routinely used and additional staining by e.g. chresyl violet staining is not applied. The Japanese and European Society for GI Endoscopy (JGES and ESGE) have started a collaboration to share their experience and stimulate this area of clinical expertise further. At this moment, a study is prepared to evaluate the learning curve and clinical outcomes of an e-learning system for JNET between Japanese and Western endoscopists, including experts as well as non-experts. |
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