346 Chin J Gastroenterol 2015 Vol. 20 No LST 5. en bloc resection 6. / 2 mm 1 7. complete resection /R0 resection 8. curative resection 9. / loc

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1 * colorectal cancer CRC WHO 20% 1 WHO % 5 2. low-grade 12% 2 intraepithelial neoplasia LGIN 5 90% 2 high-grade intraepithelial neoplasia HGIN 3. traditional serrated adenoma TSA / sessile serrated adenoma / 4 polyps SSA /P a > 10 mm b c 1. DOI /j. issn * net wangguiq@ 126. com drjiang@ 163. com IBD SSA /P TSA 8 SSA /P TSA 9 SSA /P 4. laterally spreading tumor LST 10 mm

2 346 Chin J Gastroenterol 2015 Vol. 20 No LST 5. en bloc resection 6. / 2 mm 1 7. complete resection /R0 resection 8. curative resection 9. / local recurrence /residual / interval colorectal cancer post-colonoscopy colorectal cancer PCCRC / / ~ ~ %

3 % 3. 6% 40. 0% 14. 4% 77. 9% % ~ 20% % 25 36% ~ 63% % 5 > 50% 2 < 40% > 50 38% BMI 5 19% RR /10 27% 18 20% meta % 3. 4% 6. 9% IBD 20% IBD 10 2 ~ 4 22 meta UC % CI 2. 1 ~ UC 2014

4 348 Chin J Gastroenterol 2015 Vol. 20 No BMI ~ 6 0 ~ 2 Septin ~ ~ BMI < 25 kg /m kg /m ~ ~ 75 2 FOBT 3 UC CD hereditary nonpolyposis colorectal cancer HNPCC Lynch HNPCC MLH1 MSH2 SM1 20 ~ 25 1 /3 SM2 1 /3 SM3 2 ~ ~ 2 1 / SM1 < μm 39 MSH6 42 PMS ~ 30 2 ~ ~ 50 1 ~ / 2 / 3 * 4. 1 / 4. 2 * * 5 * % ~ 50% 30 44

5 ifobt 48 APC familial adenomatous polyposis FAP 2. Septin 9 FAP attenuated FAP AFAP Gardner Turcot Septin 9 APC APC Septin 9 10 ~ 12 1 ~ % ~ 95. 6% AFAP 84. 8% ~ 99% ~ ~ % 87. 4% ifobt 50 Septin 9 MUTYH MUTYH-associated poly- AFAP 55 AFAP 18 ~ 20 posis MAP CCE 52 - Peutz-Jeghers syndrome PJS 18 2 ~ 3 DNA juvenile polyposis JPS 15 2 ~ 3 1 FOBT gfobt CFDA 74. 8% 97. 5% microrna FOBT % 42. 4% gfobt FOBT 47 2 FOBT ifobtgfobt 5 3 FOBT gfobt 1.

6 350 Chin J Gastroenterol 2015 Vol. 20 No. 6 2 ~ 3 L PEG PEG 6 min 60 PEG PEG SF-PEG h 1 4 h 6 h 1 ~ d Kudo h narrow band imag- ing NBI Fuji intelligent chromoendoscopy FICE I-Scan ~ % 85% 63 NBI

7 NBI Sano CLE narrow-band imaging international colorectal endoscopic classification NICE AFI FICE I-Scan NBI 6. autofluorescence imaging 7. blue laser imaging BLI 5. confocal laser endomicroscopy CLE BLI CLE NBI CLE 66 Ⅰ pit Ⅱ pit TSA SSA /P Ⅲ S Ⅱc pit pit Ⅲ L pit pit Ⅳ pit Ⅳ B pit Ⅳ V Ⅴ I Ⅲ S Ⅲ L Ⅳ pit Ⅴ N pit 6 61 pit pattern

8 352 Chin J Gastroenterol 2015 Vol. 20 No > 85% CLE % Ottawa Aronchick 1 ~ 2 2. > 95% 95% 2 ~ 4 80% < 6 min 68 > 6 min NBI 28. 3% 11. 8% 9 min 74 endoscopic submucosal dissection ESD 6 min adenoma detection rate ADR % < 5 50 ADR > 20% > 25% > 15%

9 ADR μm 88 ADR 1. 0% 3. 0% 4. endoscopic ultrasound EUS ADR > 33. 5% EUS EUS mini-probe EUS 78 ADR 79 meus endorectal ultrasound ERUS meus T1 5. < 1 < 1% ERUS T CT MRI 92 EUS N CT 95% T 67% N CT MRI 6. MRI PET-CT 83 CT NBI MRI PET-CT Ⅱa 0-Ⅱb LST 0-Ⅱc LST < 2% 0-Ⅱc LST NBI > 36% 0-Ⅱc > 1 cm > 70% 67 LST CT meus 10 mm ERUS MRI 84 LST 30% PET-CT Ⅴ Ⅴ I 5 Ⅴ I Ⅴ I Ⅴ N 90% Ⅴ I < μm Ⅴ N > μm NBI NICE 1 87 Ⅴ I N 12 MHz meus 91 69% 94 NICE 8 NBI NICE 2 endoscopic NICE 3 mucosal resection EMR ESD

10 354 Chin J Gastroenterol 2015 Vol. 20 No. 6 c Tis T1 TNM T M SM > 5 mm > 1 cm ESD 10 EMR 100 ESD ESD min min ESD EMR ESD % ~ 98. 3% % ~ 92. 0% ESD % ~ 78. 6% 62. 4% ~ 74. 0% ESD 2 ~ 5 cm endoscopic piecemeal mucosal resection EPMR EMR > 2 cm 85. 5% ~ 98. 3% 83. 3% ~ 97. 6% ESD / EMR EMR 9 3 EMR plasma coagulation APC photodynamic 85% 68. 6% ~ 86% mm 19. 9% ~ 30. 7% EMR 71. 7% ~ 87. 4% 70. 6% ~ 91. 7% > 90% ESD 1 EMR IT Dual Hook SSA /P 3 ESD 4 cm cm 113 ESD argon therapy PDT

11 A Is B C D 9 EMR A LST B C D 10 ESD 2 3 ESD ESD ESD EMR 20 mm EMR EPMR 1 20 ~ 30 mm LST ESD CO LST- 2LST- > 30 mm 5 5 ~ 7 d 5 mm Ⅰ EMR 1 5 ~ 20 mm 2 > 10 mm Is SSA /P 3 EPMR 10 mm 2 ESD > 30 mm LST EPMR / ESD 1 > 20 mm EMR > 20 mm 3Ⅴ I UC 4

12 356 Chin J Gastroenterol 2015 Vol. 20 No ASA Ⅲ HNPCC UC ESD 5 72 h μm < μm EMR ESD % % % % % Yoshida EMR / EMR / Hurlstone EMR / / Moss EMR / * Buchner EMR * Park EMR Saito ESD / Lee ESD ESD Tseng ESD / Farhat ESD / Hurlstone ESD EMR EPMR / * /

13 h 133 p 11 EMR % ~ 18% % ~ 7. 2% ESD 0 ~ 3. 6% CT EMR <1.5% ESD 0. 8% ~20. 4% ESD 2. 9% ~ 14. 5% EMR ESD LST ESD CO 2 EMR 0-Ⅱa + Ⅰs 10 mm > 90% 151 OTSC over-the-scope clip ESD 137 EMR 1. 0% ~ 3. 1% % ~ 3. 0% ESD 0 ~ 15. 6% h 1. 4% ~ 12. 5% > 20 mm EMR ESD % ~ 0. 1% 153 ESD 154 ESD ESD > 30 mm APC APC 145 EMR 1. EMR 0. 8% ~ 7. 2% EMR EPMR

14 358 Chin J Gastroenterol 2015 Vol. 20 No. 6 / 20. 4% ~ 27% meta EMR 15% 20% 3% ESD 0 ~ 2. 0% EMR ESD OR EMR 0 ~ 3. 2% ESD 0 ~ 4. 9% Kwong 2. Ming Fock NBI 160 APC ~ / / 6 6 / William Tam Lyell McEwin 3 ~ 5 < 10 mm 2 ~ 3 1 ~ 2 < 10 mm 1 ~ 3 3 ~ 10 1 ~ 2 > > 10 mm 1 ~ ~ 2 1 ~ 2 < 10 mm 2 ~ 3 10 mm 1 ~ 2 TSA Elsevier WHO > 20 1 International Agency for Research On Cancer. World Health 1 Organization. GLOBOCAN 2012 Estimated Cancer Incidence Mortality and Prevalence Worldwide in 2012 > 10 mm 2 EB /OL http / /globocan. iarc. fr /

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