← Issue №5/ week of Aug 2, 2026/Colorectal

Characteristics of small early colorectal cancer in the non-pedunculated lesions and its relationship with the depth of invasion.

From GI Signals issue №5: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Colorectal retrospective · n=289 · Jul 30, 2026 · BMC Gastro · IF 2.5

Characteristics of small early colorectal cancer in the non-pedunculated lesions and its relationship with the depth of invasion.

New evidencecolorectal cancerepidemiology
Clinical takeawayDuring colonoscopy, consider endoscopic resection (ESD) for non-pedunculated lesions <2 cm with surface fullness, dilated peripheral vessels, JNET2B/3 morphology (JNET2B: irregular surface and/or irregular vessels; JNET3: markedly irregular surface and/or vessels), or de novo carcinoma features due to high deep invasion risk. This applies particularly to patients with a mean age of 63 years and a male predominance (60.9%).
What it foundSurface fullness (OR=13.81), dilated blood vessels in tumor periphery (OR=6.44), JNET2B (OR=6.43), JNET3 (OR=22.94), and de novo carcinoma pathway (OR=21.61) independently predicted deep submucosal invasion in small (<2 cm) non-pedunculated early CRC compared to standard endoscopic assessment.
ContextChallenges the assumption that small CRC size alone predicts lower aggressiveness; provides specific endoscopic features (including JNET classification specifics) to stratify invasion risk in sub-2 cm lesions. The study is retrospective and lacks data on adverse events or limitations of ESD in this context.
Refinessuggested applicable standard· US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020

Decision at stakedetermining the risk of deep submucosal invasion in non-pedunculated colorectal lesions <2 cm

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed. Confirm complete resection and adequate prep before applying an interval, and use site-check/tumor-board pathways for piecemeal resection and malignant (T1) polyps. Refer for genetic evaluation when Lynch, FAP/AFAP/MAP, or serrated polyposis syndrome criteria are met.

US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020 · reviewed 2026-07-23 ↗
Li YB … Yin XY · BMC Gastroenterology · IF 2.5 · PubMed ↗Permalink
← Read the whole of issue №5 Every paper GI Signals surfaces gets a page like this one. All issues