Endoscopic submucosal dissection for early gastrointestinal malignancies: Current state and future perspectives

Table 1 Morphological classification of polyps

Endoscopic appearance	Paris class	Description
Protruded lesions	Ip	Pedunculated polyps
	Isp	Semi-pedunculated polyps
	Is	Sessile
Flat elevated lesions	0-IIa	Flat elevation of mucosa
	0-IIa/c	Flat elevation with central depression
Flat lesions	0-IIb	Flat mucosal change
	0-IIc	Mucosal depression ≤ 1.2 mm
	0-IIc/IIa	Mucosal depression with raised edge
Excavated lesions	0-III	Mucosal depressions > 1.2 mm

Table 2 Submucosal invasion in different Paris classification lesions

Paris classification	Submucosal invasion, %
0-Ip	5
0-Is	34
0-IIa	4
0-IIb	0
0-IIc	61

Table 3 Narrow band imaging International Colorectal Endoscopic classification

Endoscopic appearance	NICE type
Lesions with a color similar to the surrounding mucosa may have a net-like vascular pattern or lack a specific vascular pattern	1
Lesions with a brownish hue with brown vessels surrounding white structures	2
Lesions with a dark-to-brown appearance, disrupted or missing vessels, and an irregular surface pattern	3

NICE: Narrow band imaging International Colorectal Endoscopic.

Table 4 Japanese Narrow Band Imaging Expert Team classification

JNET type	Vessel pattern	Surface pattern	Most likely histology
1	Invisible	Regular dark or white spots, similar to surrounding normal mucosa	Hyperplastic polyp/sessile serrated polyp
2A	Regular caliber and regular distribution	Regular	Low grade intramucosal neoplasia
		Tubular/branched/papillary
2B	Variable caliber, irregular distribution	Irregular or obscure	High grade intramucosal neoplasia
3	Loose vessel areas, interruption of thick vessels	Amorphous areas	Deep submucosal invasive cancer

JNET: Japanese Narrow Band Imaging Expert Team.

Table 5 Factors for which additional treatment after endoscopic submucosal dissection should be recommended

Esophagus	Stomach	Colon and rectum
Tumors in contact with or invading the muscularis mucosa	Positive lateral margins	Positive vertical margins at the site of submucosal invasion
Tumors invading the submucosal layer	Deep submucosal invasion, regardless of positive vertical margins (> 500 μm)	Vascular or lymphatic invasion
	Vascular or lymphatic invasion	Depth of submucosal invasion greater than 1000 μm
	Diffuse type histology	Vascular or lymphatic invasion