Endoscopic Assessment of Early Neoplasia in the Gastrointestinal Tract

Endoscopic detection and evaluation of early neoplasia in the gastrointestinal tract should be carried out by systematic assessment of a standard set of lesional characteristics. First of all, attention should be given to the microvasculature and pit pattern of the mucosal surface. These features can distinguish neoplastic from non-neoplastic lesions and are used to assess the presence of dysplasia or malignancy. High resolution endoscopy combined with narrow band imaging usually provides sufficient detailed visualisation for characterisation. Secondly, estimating the risk of invasion beyond the mucosal layer is important, because the depth of invasion corresponds to the risk of lymph node metastasis. This prediction can be based on the gross morphology according to the Paris classification, but also size, the presence of converging folds with clubbing, ulceration and discoloration are considered predictive characteristics. This editorial provides a practical approach to assessing early neoplasia in the gastrointestinal tract. We would encourage endoscopists to appreciate these features systematically before proceeding to endoscopic or even surgical resection.