The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002

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Superficial neoplasia at endoscopy

A neoplastic lesion is called “superficial” when its endoscopic appearance suggests that the depth of penetration in the digestive wall is not more than into the submucosa, i.e., there is no infiltration of the muscularis propria. In the esophagus, neoplasia develops in the stratified squamous epithelium or in a metaplastic columnar mucosa (Barrett's esophagus). Distal to the esophagus, neoplasia develops in the columnar mucosa in the stomach. A distinction is made between tumors located at the

Endoscopic detection and chromoendoscopy

Recent models of videoendoscopes meet the requirements for the acquisition of a high-quality digital image in terms of resolution, color reproduction, contrast, and structure enhancement. The primary step in diagnosis is to identify the presence of an area of the mucosa slightly discolored (more pale or more red), an irregular microvascular network, or a slight elevation or depression.

The second step in diagnosis is based on chromoendoscopy, to help in the meticulous description of the lesion.

Endoscopic morphology of subtypes within type 0

In the Japanese studies, there are several large series showing the distribution and variations in the morphology of superficial neoplastic lesions type 0. Some series include the endoscopic description of the lesion with its corresponding histopathology. In series from endoscopy units, the pathology component is the weak point, while endoscopic description is the weak point in series from a surgical unit or a pathology laboratory. The relative proportions of each type and subtype vary

Minimal standard terminology for the endoscopic classification

The classification of type 0 lesions is based on the distinction between polypoid (type 0-I); non-polypoid, nonexcavated (type 0-II); and non-polypoid, excavated (type 0-III) lesions. In addition, type 0-II lesions are divided with respect to the absence (type 0-IIa and 0-IIb) or the presence of a depression (type 0-IIc). This minimal standard terminology (Table 1, Table 2) covers most of the clinical relevance of the morphology and applies to esophagus, stomach, and colon. The site-specific

Recent trends in endoscopy

The precise classification of all endoscopic mucosal lesions is greatly facilitated by high-quality endoscopic imaging. Chromoendoscopy further increases the yield of abnormal findings, especially small, non-polypoid lesions. In the large bowel, small non-depressed neoplastic lesions are frequent, their risk of progression to cancer is small, and they must be differentiated from non-neoplastic, hyperplastic lesions, which have virtually no additional risk for cancer. The choice between

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