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PubMed2000

[Acute pseudo-obstruction of the colon as complication of hip surgery].

Pseudo-obstruction of the colon is characterized by a massive colonic dilatation without mechanical obstruction. It is rarely after hip surgery, however, untreated it may be complicated by a life threatening perforation of the colon. In a retrospective analysis we reviewed 11 patients (4 women, 7 men, mean age 75.2 years, range 67 to 86 years) with pseudo-obstruction of the colon after hip surgery in the years 1995 to 1998. In relation to all patients aged 65 years and older who underwent surgery of the hip, the prevalence was 1.06%. The leading clinical symptom was abdominal distension. On plain x-rays, dilatation of the colon measured 13.3 cm on average (9-16 cm). In two patients (18%) adequate application of drugs stimulating the gastro-intestinal motility was sufficient, whereas in 8 patients (73%) colonoscopic decompression had to be performed. In three of these, the procedure failed and because of persistent symptoms a cecostomy was performed. One patient underwent immediate laparotomy because of peritonitis. 2 patients (18%) died because of a complicated course. Non operative treatment should not exceed 24 hours, endoscopic decompression and tube placement is considered as the treatment of choice. In cases of failure of these procedures, perforation of the colon and/or peritonism, urgent laparotomy with open decompression by a cecostomy is essential.

Acute Disease↗
PubMed2003

[Importance of coloncontrast enema].

Screening for colorectal cancer starts with digital exploration of the rectum and was extended in 1977 using the haemoccult test. It was referred to detect 24% of malignancies, but with a high number of false positive findings. Combination of regular follow up examinations and coloscopy reached a sensitivity of 80%. International studies demonstrated the need of a complete colon examination, so that the coloscopy is actually an important screening method in Germany. The coloncontrast examination is a safe, cost-effective method with a low complication rate. It is suitable especially for patients, in which the colonoscopic evaluation of the colon was not complete and provides additional morphological informations in many cases.

Adenomatous Polyps↗
PubMed2005

Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding.

OBJECTIVE: To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding. DESIGN AND SETTING: A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan. PATIENTS AND PARTICIPANTS: Fifty-five people undergoing bedside colonoscopy for lower GI bleeding that developed while in the ICU. INTERVENTIONS: Bedside colonoscopy. MEASUREMENTS AND RESULTS: Colonoscopy was successful in diagnosing the source of bleeding in 37 patients. Among them, colitis (15 patients, including ischemic, pseudomembranous, or radiation-induced) and acute hemorrhagic rectal ulcer (nine patients) were the most frequent confirmed causes. In seven patients, fresh blood was noticed above the colonoscopically accessible area and considered to originate from the small bowel. No adverse event was associated with colonoscopy. Spontaneous cessation of bleeding was noted in 29 (29/55, 53%) patients, whereas 16 (16/55, 29%) achieved endoscopic hemostasis. Ten (10/55, 18%) patients failed primary hemostasis or localization. Overall in-hospital mortality was 53% (29/55); however, hemorrhage-related death occurred in only two patients. CONCLUSIONS: ICU patients with acute lower GI bleeding have distinctive causes. Bedside colonoscopy is effective for diagnosis in two-thirds of patients, but only a minority of them needs endoscopic hemostasis.

Acute Disease↗
PubMedDate not supplied

Peritoneal lymphomatosis: CT findings.

BACKGROUND: Diffuse peritoneal tumor infiltration is well recognized on computed tomography (CT) and is usually associated with carcinomatosis. The purpose of this investigation was to analyze the CT findings of peritoneal spread from primary gastrointestinal lymphomas. METHODS: Abdominal CT scans in eight patients with peritoneal lymphomatosis were retrospectively reviewed. Patients were 12-75 years old (mean = 48 years); with six patients were male and two were female. Pathologic evidence of primary lymphoma was available by colonoscopic biopsy of the terminal ileum in seven cases and by gastroscopic biopsy of the stomach in one case. All patients had non-Hodgkin's lymphoma. We analyzed CT findings in view of presence or loculation of ascites, abnormal patterns of mesentery and omentum, presence of peritoneal enhancement, presence of low attenuation and location of lymph nodes, and primary gastrointestinal lymphoma. RESULTS: Although ascites was present in all patients, there was no loculation. The involvement of mesentery was present in seven patients, and the stellate pattern was the common type (4/7). The involvement of omentum was present in seven patients, and the common type was omental cake (3/7). Peritoneal enhancement was present in six patients. Enlarged lymph nodes were present in six patients, mainly at the retroperitoneum and mesentery, and showed centrally low attenuation in half the patients. CONCLUSION: Patterns of tumor involvement of mesentery, omentum, and peritoneum seen in peritoneal lymphomatosis are indistinguishable from those seen in peritoneal carcinomatosis or tuberculous peritonitis. However, ascites without any loculation or septation and diffuse distribution of enlarged lymph nodes were helpful signs of peritoneal lymphomatosis.

Adolescent↗
PubMedDate not supplied

Adult Crohn disease: can ileoscopy replace small bowel radiology?

BACKGROUND: This study aimed to document the radiological features and distribution of small bowel Crohn disease (CD) in adults by using a barium follow-through (BaFT) technique and to determine whether disease would be missed or its distribution underestimated if only colonoscopy with ileoscopy were performed. METHODS: The BaFT examinations of 121 adults with proven CD were reviewed retrospectively with respect to the stage and distribution of disease. Colonoscopy with attempted ileoscopy was performed in 37 of these subjects, and the results were compared with radiological findings. RESULTS: A normal villous pattern was visualized in 89 studies (74%). BaFT showed small bowel CD in 71 (59%) of 121 patients studied. The terminal ileum (TI) was the most common site of disease, affecting 62 (87%) of patients with small bowel CD. Forty-six patients (65%) had more proximal small bowel disease, including nine (13%) with a normal TI. BaFT showed early mucosal changes of CD in 52 subjects (73%), which was the sole manifestation in 15 (21%). Ileoscopy was possible in the majority of patients colonoscoped but was not achieved in 14 (38%), nine of whom had CD on BaFT. Of the 23 patients in whom ileoscopy was performed, findings agreed with BaFT assessment of the TI in 22. CONCLUSION: BaFT adequately demonstrates the stage and extent of small bowel CD. The majority of patients with small bowel CD have disease proximal to the TI, which cannot be diagnosed by ileoscopy.

Adult↗
PubMed2004

Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients.

The incidence, risk factors, and clinical relevance of stenosis of stapled colorectal anastomosis (CRA) were studied prospectively. Anastomotic stricture was defined as the inability of traversing the anastomosis with the rigid proctoscope. The population studied consisted of 179 patients (94 males) with an average age of 59.3 years (range: 20 to 91 years). The main indication for surgery was colorectal cancer in 59% of the cases, followed by diverticular disease in 23%. The first endoscopic control was performed before 4 months in 25% of the patients, between 5 and 10 months in 50%, and during the following 10 months in 25%. Stenosis was verified with the rigid instrument in 21.1% of the cases and with the flexible colonoscope in 4.4%. The barium enema performed in 12 cases confirmed a punctiform stenosis in 5 patients, 4 of whom had been asymptomatic. An endoscopic dilatation was performed on 5 of the 8 symptomatic patients, with one relapse that required an additional dilatation. In the univariate analysis only the lesser 4-month interval was statistically significant (p = 0.033; odds ratio (OR) = 2.3; confidence interval (CI) 95% = 1.06 to 4.97). Male patients (p = 0.057; OR = 2.08; IC 95% = 0.97-4.44) show a tendency to CRA stricture that does not reach statistically significant levels. In the multivariate analysis, only sex (p = 0.04; OR = 4.11; IC 95% = 1.03 to 5.41) and the time interval (p = 0.012; OR = 2.87; IC 95% = 1.25 to 6.57) appear as independent variables in stenosis risk of a stapled CRA. The incidence of this complication depends on the criteria used for defining it. It is clinically relevant in no more than 5% of the patients. Five out of eight patients in category II were treated successfully with an endoscopic dilatation, while the other three improved spontaneously. Early stenosis, although frequent, is generally asymptomatic and disappears spontaneously. Considering the lack of correlation between the degree of stricture and its symptomatology, it is convenient to combine both the anatomic and the clinical criteria in the selection of candidates for an eventual therapeutic procedure.

Adult↗
PubMed2004

Cribriform-morular variant of papillary thyroid carcinoma: clue to early detection of familial adenomatous polyposis-associated colon cancer.

The cribriform-morular variant (CMV) of papillary thyroid carcinoma (PTC) is a rare histologic subtype of PTC that shows a combination of growth patterns including cribriform and spindle cell areas. The thyroid cancer with this unique histology was originally reported in patients with familial adenomatous polyposis (FAP), although it was later found in patients without polyposis as well. Because of its rarity, its clinical features are not clear. We reviewed seven patients with CMV-PTC who were found among 4194 patients with PTC in our pathology files between June 1991 and March 2003. The prevalence of CMV was 0.16% among all PTCs. We invited these patients to our hospital so we could obtain a detailed family history and recommend colonoscopic examination and germline APC gene analysis. Two patients without subjective symptoms had polyposis of the colon and colon cancers. Germline APC gene mutations were found in both patients. The father of a patient who refused the invitation was revealed to have undergone surgery for colon polyposis. In the remaining four patients, neither polyposis nor APC gene mutation was found. Common clinical features included a young age (mean 25 years), predominance of females, circumscribed tumors, negative node metastasis, and no recurrence of the thyroid cancer after surgery. Two of the three patients with colon polyposis had bilateral multiple thyroid tumors, whereas the remaining four (without polyposis) had a solitary tumor. The histopathology of CMV in patients with PTC should arouse a suspicion of FAP, especially if there are multiple tumors. This finding can lead to early detection of colon cancer.

Adenomatous Polyposis Coli↗
PubMed2005

Surgical treatment of chronic amebic colitis.

There are limited data concerning the surgical management of chronic amebic colitis (CAC) in the literature. We present our experience with 10 patients with CAC treated surgically. Patients' records were retrospectively analyzed for age, sex, duration of clinical manifestations, colonoscopic findings, the type of surgical operation, and the postoperative course. Total proctocolectomy and J-pouch construction was performed in two patients who had CAC with severe rectal involvement. Total colectomy and the Hartmann procedure was performed in eight patients with mild to moderate rectal involvement. This treatment was successful in preserving the rectum in four of the eight. Our results suggest that rectal preservation can be a reliable treatment option in patients with CAC who have mild to moderate rectal involvement. Total proctocolectomy and ileoanal anastomosis with pouch construction should be the treatment of choice for patients with CAC who have severe rectal involvement.

Adult↗
PubMed2005

Surgical treatment of appendiceal adenocarcinoid (goblet cell carcinoid).

Adenocarcinoid of the appendix is an infrequent tumor with histologic features of both adenocarcinoma and carcinoid tumor. Although its malignant potential remains unclear, adenocarcinoids seem to be biologically more aggressive than conventional carcinoids. The aim of this study was to analyze long-term results of surgical treatment for appendiceal adenocarcinoid. A retrospective review (1991-2003) identified seven patients (median age 72, range 27-81 years) treated for appendiceal adenocarcinoid. The clinical data of these patients were reviewed. Follow-up was complete for all patients (median 60 months, range 24-108 months). Most cases presented with associated acute appendicitis (71%). First intention surgery consisted of appendectomy (m = 6) and right hemicolectomy (m = 1). In three patients, additional surgical procedures were performed (right colectomy). Indications for colectomy were tumor size (three cases) associated with appendectomy margin invasion in one case. One patient with lymph node and peritoneal involvement experienced recurrence 9 months after hemicolectomy and died of the disease at 2 years. One patient subsequently died of colon carcinoma 6 years after adenocarcinoid treatment. Five patients were alive without disease at the time of the last follow-up. Synchronous or metachronous colon carcinomas developed in three patients (43%). Our results suggest that appendectomy alone could be used for appendiceal adenocarcinoid provided that the tumor (1) is less than 1 cm; (2) does not extend beyond the appendix adventitia; (3) has less than 2 mitoses/10 high power fields; and (4) has surgical margins that are tumor free. Otherwise, carcinologic right colectomy seems to be indicated. The risk for developing colorectal adenocarcinoma seems to be extremely high in patients treated for appendiceal adenocarcinoid and warrants close follow-up with colonoscopic screening.

Adult↗
PubMed2000

Surgical management of early colorectal cancer.

An early colorectal carcinoma is TNM stage T1NxMx. Most early carcinomas of the colon and rectum can be treated by adequate local excision, such as colonoscopic polypectomy and per-anal excision. If there are adverse risk factors, especially poorly differentiated carcinoma, lymphovascular invasion, or incomplete excision, a radical resection is indicated if there is no contraindication. In the case of a low rectal carcinoma, adjuvant chemoradiation should be considered. Recently a new classification has been developed: sm1 is invasion to the upper one-third of the submucosa, sm2 is invasion to the middle one-third, and sm3 is invasion to the lower one-third. Lesions of sm1 and sm2 have a low risk of local recurrence and lymph node metastasis; local excision is adequate. The sm3 lesions and sm2 flat and depressed types have a high risk of local recurrence and lymph node metastasis; further treatment is indicated.

Colonic Neoplasms↗
PubMed2000

Radiographic diagnosis of early colorectal cancer, with special reference to the superficial type of invasive carcinoma.

The possibility of radiographically diagnosing carcinoma with submucosal involvement (invasive carcinoma) is discussed based on 119 invasive carcinomas of the large bowel that had been treated surgically and colonoscopically over a period of 9 years (1989-1997) at the Cancer Institute Hospital in Tokyo. Of these lesions, 38 were superficial-type invasive carcinoma, accounting for 31.9% (38/119) of all invasive colorectal carcinomas, including 36 lesions (94.7%, 36/38) of types IIa and IIa + IIc and 2 lesions (5.3%, 2/38) of type IIc + IIa. No pure type IIc was seen. The radiographic images obtained were correlated with macroscopic findings and analyzed in terms of visualization of the lesion's contour, central depression, converging folds, and basal indentation. A definitive diagnosis of superficial invasive carcinoma can be made radiographically if a lesion measures 10 mm and reveals moderate to severe basal indentation in a complete or nearly complete profile radiographic image. Attention should be paid to the presence of superficial-type advanced carcinomas measuring 10 mm or less, which is not infrequently experienced in Japan. Polypoid invasive carcinoma can be definitively diagnosed in the same way with much more certainty than can the superficial type because few polypoid advanced carcinomas are less than 20 mm. The size and the radiographic sign of the basal indentation are the most important indicators for the diagnosis of invasive carcinoma.

Adenoma↗
PubMed1996

Screening by genomic linkage studies and mutation analysis of hereditary adenomatous polyposis coli: usefulness for clinical practice.

A heterogeneous group of patients suffering from adenomatous polyposis coli (APC) were evaluated by clinical and genetic investigations for the first time in Austria. The patients belonged to eight unrelated APC families. In six families several family members were affected with APC, and linkage analysis with highly informative markers was used to estimate the risk of single individuals in these families to develop APC. All index patients were also tested for the most frequent mutation in the APC gene (mutation cluster region, exon 15). Clinical investigations included ophthalmologic tests for congenital hypertrophy of retinal pigment epithelium and colonoscopy. According to DNA analysis, 5 of 19 at-risk individuals had to be considered to be at high risk of having inherited the disease. Four of them underwent proctocolectomy, one patient at risk is under colonoscopic surveillance. The predictive value of indirect genotype analyses reached 83.3%; direct mutation analyses allowed risk estimation in 50% of cases. Ophthalmologic investigation was informative in 75% of the families. Direct and indirect genotyping using a panel of highly polymorphic, closely linked microsatellite markers is a valuable, rapid, reliable method for establishing a presymptomatic diagnosis of APC, especially in families in which more than one affected individual is available for analysis. With regard to the onset of APC and extracolonic manifestations, the variability of APC demands clinical investigations in addition to the molecular tests for all patients and their first-degree relatives.

Adenomatous Polyposis Coli↗
PubMed2002

CT findings in isolated ischemic proctosigmoiditis.

The purpose of our study was to describe the CT features of ischemic proctosigmoiditis in correlation with clinical, laboratory, endoscopic, and histopathologic findings. Our study included seven patients with isolated ischemic proctosigmoiditis. Patients were identified by a retrospective review of all histopathologic records of colonoscopic biopsies performed during a time period of 4 years. All patients presented with left lower abdominal quadrant pain, bloody stools, and leukocytosis, and four patients had fever at the time of presentation. Four of seven patients suffered from diarrhea, one of seven was constipated and two of seven had normal stool consistency. The CT examinations were reviewed by two authors by consensus and compared with clinical and histopathologic results as well as with the initial CT diagnosis. The CT showed a wall thickening confined to the rectum and sigmoid colon in seven of seven patients, stranding of the pararectal fat in four of seven, and stranding of the perisigmoidal fat in one of seven patients. There were no enlarged lymph nodes, but five of seven patients showed coexistent diverticulosis and in three of these patients CT findings were initially misinterpreted as sigmoid diverticulitis. Endoscopies and histopathologic analyses of endoscopic biopsies confirmed non-transmural ischemic proctosigmoiditis in all patients. Isolated ischemic proctosigmoiditis often presents with unspecific CT features and potentially misleading clinical and laboratory findings. In an elderly patient or a patient with known cardiovascular risk factors the diagnosis of ischemic proctosigmoiditis should be considered when wall thickening confined to the rectum and sigmoid colon is seen that is associated with perirectal fat stranding.

Aged↗
PubMed2002

Feasibility of ultra-low-dose multislice CT colonography for the detection of colorectal lesions: preliminary experience.

Our objective was to evaluate the feasibility of ultra-low-dose scanning for multislice CT colonography in the detection of colorectal lesions. Twenty-seven patients (14 men, 13 women) with clinical indication for conventional colonoscopy were recruited. Multislice spiral CT (Somatom Plus 4 Volume Zoom, Siemens, Germany) examinations were performed after standard oral colonoscopic preparation and colonic distension with room air. Images were acquired using 2.5-mm collimation, 3.0-mm slice thickness, standard reconstruction kernel, 140 kVp, and 10 mAs. Supine and prone acquisitions were obtained in all patients. Images were analyzed on a workstation by two gastrointestinal radiologists. Conventional colonoscopy was performed on the same day in all patients and represented the standard of reference. Total radiation exposure was also calculated. All colorectal cancers were correctly identified at CT colonography (9 of 9, sensitivity 100%). The CT colonography also detected 10 of 12 polyps (overall sensitivity 83.3%). Based on polyp diameter, the sensitivity for the detection of polyps 10 mm or larger was 100% (3 of 3); between 6 and 9 mm, 100% (3 of 3); and 5 mm or smaller, 66.6% (4 of 6). Total radiation exposure for prone and supine acquisitions combined was 1.7 mSv (for men) and 2.3 mSv (for women). Although preliminary, our experience suggests that ultra-low-dose scanning for multislice CT colonography is feasible. This technique provides a sensitivity comparable to that of previous experiences with CT colonography but with a 40-70% reduction of the radiation dose delivered to patients.

Butylscopolammonium Bromide↗
PubMed2002

CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography.

The aim of this study was to calculate pre- and postcontrast CT attenuation values of benign colorectal polyp and carcinoma lesions detected by virtual colonoscopy, and to investigate whether contrast enhancement of these lesions can be potentially used for differentiation from residual fluid in the colon. Fifteen benign polyps and 21 colorectal carcinoma lesions detected by virtual colonoscopy in 18 patients were included in our study. All of the polyps and carcinoma lesions were confirmed by colonoscopic biopsy. Measurement of CT attenuation values was performed in precontrast (supine) and postcontrast (prone) scans for each polyp and carcinoma. The CT attenuation values of residual fluid in the colon was also measured from the same location before and after intravenous contrast administration. On unenhanced CT scan mean attenuation values of benign polyps and colorectal carcinomas were 32.4 and 42.6 HU, respectively. Following contrast enhancement, mean attenuation value increased to 78.9 HU for polyps and 90.7 HU for carcinomas. Increase in the CT attenuation values of these lesions was significant ( p<0.0001). Mean CT attenuation value of residual fluid before and after administration of IV contrast were 14.6 and 13.8 HU, respectively. The difference between CT attenuation value of residual fluid in the colon before and after contrast material was not significant ( p=0.29). Colorectal benign polyps and carcinomas demonstrate significant enhancement following contrast administration and use of intravenous contrast material during virtual colonoscopy may help in some cases in differentiating these solid lesions from residual colonic fluid that does not enhance.

Colonic Polyps↗
PubMed2005

CT colonography with fecal tagging after incomplete colonoscopy.

The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.

Adult↗
PubMed2006

The diagnostic value of multiplanar reconstruction on MDCT colonography for the preoperative staging of colorectal cancer.

The purpose of this study was to determine whether multiplanar reconstruction (MPR) images can improve the accuracy of MDCT-based colorectal cancer preoperative staging by receiver-operating characteristic (ROC) analysis. Fifty-five patients with colorectal cancer underwent contrast-enhanced CT colonography using an 8- or 16-row scanner. Two separate interval reviews of the axial MDCT datasets with/without MPR images (coronal and sagittal) were performed independently by two radiologists blinded to both the colonoscopic and histopathologic results. At each review session, the radiologists were asked to determine the colorectal cancer TNM stage within the context of differentiating < or =T3 from T4, N0 from > or =N1 and M0 from M1 using a five-point confidence scale. The radiologists' performance for staging the colorectal cancer using axial CT datasets with/without MPR images was evaluated using ROC analysis. Sensitivities, specificities and interobserver agreement were assessed. When MPR images were added, significant improvement was achieved by both radiologists for differentiating N0 from > or =N1 in terms of both A(Z) (0.651 to 0.769; 0.573 to 0.713) and specificity (26.7 to 69.2%; 23.1 to 76.9%) (P<0.05). For T staging, ROC analysis failed to show a significant improvement in terms of differentiating < or =T3 from T4 for either radiologist (P>0.05), but a significant improvement in the specificity (70 to 90%; 80 to 92%) was achieved by one radiologist (P<0.05). In terms of the M staging, a significant improvement in the Az (0.844 to 0.996) was observed for the combined interpretation of the axial and MPR images by one radiologist (P<0.05). Furthermore, substantial or almost perfect interobserver agreement was achieved for all TNM stagings for the combined interpretations (kappa=0.641-0.866), whereas only fair to substantial agreement was achieved for the axial images alone (kappa=0.337-0.707). In conclusion, the combined interpretation of the axial and MPR MDCT images significantly improved the local staging of colorectal cancer compared with assessments based on axial images alone.

Adult↗
PubMed2002

Evaluation of endoscopic ultrasonography in colorectal villous lesions.

BACKGROUND AND AIMS: The choice of therapeutic procedure for colorectal neoplasias depends largely on the depth of tumor invasion. This study examined the value of endoscopic ultrasonography (EUS) in determining whether local resection is applicable for colorectal villous lesions. MATERIALS AND METHODS: We performed EUS on 125 colorectal neoplasias classified into two categories, villous ( n=35) and nonvillous lesions ( n=90), according to their colonoscopic morphological features. We compared the EUS and clinicopathological findings for each lesion. RESULTS: The overall accuracy of EUS-based evaluation of tumor invasion depth was 60% in villous lesions and 91% in nonvillous lesions. In villous lesions 37% were overstaged and 3% understaged, and in of nonvillous lesions 6% were overstaged and 3% understaged. In differentiating mucosal neoplasias (M)/submucosal cancers with slight invasion (SM-s) from non-M/SM-s, the values in villous and nonvillous lesions were, respectively: sensitivity 60% and 86%, specificity 100% and 99%, and accuracy 66% and 96%. Large (>/=20 mm wide, >/=5 mm high) or rectal villous lesions were more likely than nonvillous lesions to be misjudged with regard to the differentiation between M/SM-s and non-M/SM-s. CONCLUSION: It is difficult to determine the depth of invasion in villous lesions, especially large or rectal lesions, using only EUS. EUS-based evaluation alone cannot determine the appropriate treatment for colorectal villous lesions.

Adenoma, Villous↗