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Submucosal xanthachromia after endoscopic mucosal resection: laparotomy or conservative therapy?
  1. Hisashi Nakamura1,
  2. Kuang-I Fu2,
  3. David Paul Hurlstone3,
  4. Yasushi Kaji4,
  5. Takahiro Fujimori5
  1. 1Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan
  2. 2Department of Radiology, Dokkyo Medical University, Tochigi, Japan
  3. 3Department of Endoscopy, Royal Hallamshire Hospital, Sheffield, UK
  4. 4Department of Radiology, Dokkyo Medical University, Tochigi, Japan
  5. 5Department of Surgical and Molecular Pathology, Dokkyo Medical University, Tochigi, Japan
  1. Correspondence to:
    Dr D P Hurlstone
    17 Alexandra Gardens, Lyndhurst Road, Nether Edge, Sheffield, S10 2JF, UK; p.hurlstone{at}shef.ac.uk

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A screening colonoscopy was performed on an asymptomatic 68-year-old woman. A diminutive 1 mm diameter Paris-type 0-IIc neoplastic lesion was diagnosed in the ascending colon (fig 1A). Further characterisation using high-magnification chromoscopic colonoscopy and 0.05% crystal violet intravital staining revealed a Kudo-type IIIs crypt architecture in the depressed component, which suggested that this lesion was limited to the mucosal layer. Endoscopic mucosal resection (EMR) was considered to be the most appropriate firstline endoluminal treatment in this case to confirm histologically the absence of neoplastic disease beyond 1000 μm in the vertical margin, where data from both Japan and Europe have shown that despite diminutive endoluminal appearances, such …

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