ABSTRACT
Las lesiones planas están asociadas con mayor frecuencia a la presencia de carcinoma invasor superficial. La magnificación endoscópica permite el análisis detallado de la superficie mucosa de lesiones sospechosas y predecir, por sus características morfológicas, si son lesiones benignas o malignas, permitiendo decidir conducta terapéutica al momento del estudio. Los tumores de diseminación lateral de colon y recto, son lesiones >10mm con bajo eje vertical extendidas lateralmente a lo largo de la pared luminal. Okamoto describe dos grupos: tipo granular, endoscópicamente numerosos nódulos de color homogéneo en comparación con mucosa colónica circundante; tipo plano, lesiones con superficie plana en ausencia de formación de gránulos nodulares. Establecer utilidad de la cromoendoscopia virtual computarizada y magnificación (FICE) para la determinación de las lesiones detectadas en estudios de video colonoscopia; decidir en el momento del procedimiento, la conducta a seguir. Se utilizó el modelo de clasificación de Paris en las lesiones colorectales detectadas. Estudio retrospectivo y descriptivo en pacientes que acudieron a una consulta de centro privado, en el período Enero 2009-Marzo 2012, realizándoles video colonoscopia con FICE, con equipo Fujinon EPX-4400, por un mismo endoscopista. Se revisaron 1298 video colonoscopias, 269 casos con lesiones planas en colon de los cuales 17 (6.31%) fueron lesiones tipo II (diseminación lateral); 9 del sexo femenino (52.94%) y 8 masculino (47.05%); 7 fueron lesiones IIa no granular (41.17%), 7 IIa granular (41.17%), 2 IIc no granular (11.76%) y 1 IIc granular (5.88%). En relación a la ubicación 5 casos (29.41%), en transverso; 4 casos (23.52%) tuvieron resección endoscópica y 13 casos (76.47%) fueron referidos para resolución quirúrgica de los cuales, histológicamente: 7 fueron tubulovellosos (41,18%) y 1 de estos presentó displasia de alto grado y los 6 restantes de bajo grado....
The flat lesions are associated with a high incidence of invasive superficial carcinoma; the endoscopic magnification allows a more detailed evaluation of the superficial lesions and can predict if they will be or not malignant, allowing to take a therapeutic decision at the moment of the videocolonoscopy. These tumours are lesions no more than 10 mm, whit a low vertical axis wich extents laterally along the lumen of the colon. Okamoto describes two groups: Granular type Endoscopically are numerous nodules with the same color compared with the surrounding colonic mucosae; and the Flat type which are flat lesions without presence of nodules. To establish the utility of the virtual computerized chromoendoscopy and magnification (FICE)® in the evaluation of lesions detected in videocolonoscopies performed and in order to take a therapeutic decision. We used the Paris model for the classification of the colorectal lesions encountered at the time of the colonoscopy. We performed a retrospective and descriptive study in patients who evaluated in a private office between January 2009-March 2012, a videcolonoscopy with FICE® using a videocolonoscope Fujinon EPX 4400 ® all studies were performed by the same operator. 1298 videocolonoscopies were performed, 269 cases with flat lesions, 17 (6.31%) were lesions type II (lateral spread), 9 were females (52,94%) and 8 males (47,05%), 7 were lesions type IIa, non granular (41,17%), 7 IIa granular (41,17%), 2 IIc non granular (11,76%), and 1 IIc granular (5,88%), 5 cases (29,41%) were located in transverse colon, 4 (23,52%) were successfully removed endoscopically , and 13 (76,47) were referred for surgical treatment, in relation with the histopathology: 7 were tubulovillous (41,18%), and 1 associated with high degree dysplasia and 6 low degree dysplasia. Our study demonstrates, the usefulness of the FICE® in the detection of flat lesions and permits obtain samples for biopsy and make therapeutic decisions