Endoscopic Diagnosis and Management of Early Colorectal Neoplasia: A Narrative Review from a Japanese Perspective

Background: Colorectal cancer can be cured by minimally invasive therapies such as endoscopic or surgical treatment if detected at an early stage, and it is important to increase the number of cases detected as early as possible in terms of medical cost-effectiveness. The purpose of this article was to comprehensively review the current status of endoscopic diagnosis and management of early colorectal neoplasia from a Japanese perspective. Summary: Regarding diagnosis, qualitative diagnosis and depth diagnosis using advanced endoscopic imaging such as narrow-band imaging (NBI) and chromoendoscopy are important to determine the treatment strategy. As for endoscopic treatment, it is fundamental to select the appropriate treatment method according to lesion size and morphology, and the use of modified endoscopic resection for intermediate-sized lesions and endoscopic submucosal dissection for large lesions is an issue for the future. Conclusions: This narrative review article summarizes the current status of endoscopic diagnosis and treatment in Japan in comparison with Europe and the United States. In particular, we discuss the determination of treatment strategies based on detailed endoscopic diagnoses, advances in modified endoscopic mucosal resection (EMR) for intermediate-sized lesions, and the fact that, as a country that pioneered endoscopic submucosal dissection (ESD), Japan has a broader range of indications compared to Europe and the United States.