In Japan, neoplastic lesions of the stomach with a superficial endoscopic appearance are classified as ”type 0”. The term ”type 0” was chosen to distinguish the description of superficial lesions from the Borrmann classification for advanced gastric cancers that was proposed in 1926. The classification system for superficial gastric neoplasia was later also applied to large-bowel tumors. The development of the categorization of superficial, shallow, depressed-type neoplastic lesions, now classified as 0-IIc, has followed a similar path to that of gastric and early esophageal cancers, but with a significant delay.
Kariya et al. [1] were the first to describe the 0-IIc lesion in 1977, but until 1993, when Kudo et al. [2] reported their 0-IIc carcinoma series and classification, 0-IIc carcinomas were thought to be a uniquely Japanese phenomenon. Our colleagues Fujii & Rembacken and their co-workers [3] demonstrated 0-IIc lesions in an English population in 1998. Saitoh et al. [4] reported on the prevalence of 0-IIc lesions in North America, while Teixeira also reported 0-IIc lesions in a Latin American population [5].
In 2003, the Paris endoscopic classification of superficial neoplastic lesions in the esophagus, stomach, and colon was published by the American Society for Gastrointestinal Endoscopy (ASGE) [6] and this classification will soon be standardized worldwide. The present article highlights the distinctions between so-called ”flat” lesions and 0-IIc (superficial depressed) neoplastic colorectal lesions, and demonstrates the typical endoscopic appearance of 0-IIc lesions on standard endoscopy, chromoendoscopy, and magnifying endoscopy. In addition, the latest clinicopathological findings concerning 0-IIc lesions are discussed.
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