{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T03:58:31Z","timestamp":1778644711127,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: Large rectal lesions can conceal submucosal invasion and cancer nodules. Despite the increasing diffusion of high-definition endoscopes and the importance of an accurate morphological evaluation, a complete assessment in this setting can be challenging. Endoscopic ultrasound (EUS) plays an established role in the locoregional staging of rectal cancer, although this technique has a tendency toward the over-estimation of the loco-regional (T) staging. However, there are still few data on contrast-enhanced endoscopic ultrasound (CH-EUS), especially if this ancillary technique may increase the accuracy for predicting invasive nodules among large rectal lesions. Material and Methods: Consecutive large (\u226520 mm) superficial rectal lesions with high-definition endoscopy, characterized by focal areas suggestive for invasive cancer\/2B type according to JNET classification, were considered for additional standardized evaluation via CH-EUS with Sonovue \u00a9. Results: From 2020 to 2023, we evaluated 12 consecutive superficial rectal lesions with sizes ranging from 20 to 180 mm. This evaluation provided additional elements to support the therapeutic decision made. Lesions were treated with surgical (3\/12) or endoscopic treatment (9\/12) according to their morphology and CH-EUS evaluation. Conclusion: Contrast-enhanced endoscopic ultrasound can provide an additional evaluation for large and difficult-to-classify rectal lesions. In our experience, CH-EUS staging corresponded to the final pathological stages in 9\/12 (75%) lesions, improving the distinction between T1 and T2 lesions. Larger prospective studies and randomized trials should be conducted to support and standardize this approach.<\/jats:p>","DOI":"10.3390\/diagnostics13132267","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:37:28Z","timestamp":1688517448000},"page":"2267","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Usefulness of Contrast-Enhanced Endoscopic Ultrasound (CH-EUS) to Guide the Treatment Choice in Superficial Rectal Lesions: A Case Series"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-6322","authenticated-orcid":false,"given":"Giulia","family":"Gibiino","sequence":"first","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Sbrancia","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-9684","authenticated-orcid":false,"given":"Cecilia","family":"Binda","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Coluccio","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-7588","authenticated-orcid":false,"given":"Stefano","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4628-1130","authenticated-orcid":false,"given":"Paolo","family":"Giuffrida","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"},{"name":"Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graziana","family":"Gallo","sequence":"additional","affiliation":[{"name":"Pathology Department, M. Bufalini Hospital, Emilia Romagna, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-9596","authenticated-orcid":false,"given":"Luca","family":"Saragoni","sequence":"additional","affiliation":[{"name":"Pathology Department, G.B. Morgagni-L. Pierantoni Hospital, Emilia-Romagna, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Maselli","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-9910","authenticated-orcid":false,"given":"Carlo","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1056\/NEJMoa1100370","article-title":"Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths","volume":"366","author":"Zauber","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"ASGE Standards of Practice Committee, Fisher, D.A., Shergill, A.K., Early, D.S., Acosta, R.D., Chandrasekhara, V., Chathadi, K.V., Decker, G.A., Evans, J.A., and Fanelli, R.D. (2013). Role of endoscopy in the staging and management of colorectal cancer. Gastrointest. Endosc., 78, 8\u201312.","DOI":"10.1016\/j.gie.2013.04.163"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1055\/s-2006-925398","article-title":"Endoscopic Submucosal Dissection for Rectal Epithelial Neoplasia","volume":"38","author":"Fujishiro","year":"2006","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1055\/s-0042-118449","article-title":"Endoscopic submucosal dissection for early rectal neoplasia: Experience from a European center","volume":"49","author":"Probst","year":"2016","journal-title":"Endoscopy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.gie.2007.02.032","article-title":"Endoscopic submucosal dissection for colorectal neoplasia: Possibility of standardization","volume":"66","author":"Tanaka","year":"2007","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Hashiguchi","year":"2019","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0043-102569","article-title":"Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline","volume":"49","author":"Ferlitsch","year":"2017","journal-title":"Endoscopy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1055\/s-0034-1392882","article-title":"Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"47","author":"Ponchon","year":"2015","journal-title":"Endoscopy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1136\/gutjnl-2015-309576","article-title":"British Society of Gastroenterology\/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps","volume":"64","author":"Rutter","year":"2015","journal-title":"Gut"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1055\/s-0034-1377449","article-title":"Colorectal endoscopic submucosal dissection: When and by whom?","volume":"46","author":"Bourke","year":"2014","journal-title":"Endoscopy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1055\/a-1811-7025","article-title":"Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Update 2022","volume":"54","author":"Bastiaansen","year":"2022","journal-title":"Endoscopy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1055\/s-2004-826104","article-title":"Pit Pattern in Colorectal Neoplasia: Endoscopic Magnifying View","volume":"33","author":"Kudo","year":"2001","journal-title":"Endoscopy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00384-015-2403-7","article-title":"Practical problems of measuring depth of submucosal invasion in T1 colorectal carcinomas","volume":"31","author":"Kouyama","year":"2015","journal-title":"Int. J. Color. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/den.13065","article-title":"Validation study for development of the Japan NBI Expert Team classification of colorectal lesions","volume":"30","author":"Iwatate","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_15","first-page":"267","article-title":"Effect of pre-resection biopsy on detection of advanced dysplasia in large nonpedunculated colorectal polyps undergoing endoscopic mucosal resection","volume":"55","author":"Ma","year":"2022","journal-title":"Endoscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"638","DOI":"10.4253\/wjge.v13.i12.638","article-title":"Large polyps: Pearls for the referring and receiving endoscopist","volume":"13","author":"Markarian","year":"2021","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1007\/BF02555351","article-title":"The endosonic appearances of normal colon and rectum","volume":"29","author":"Beynon","year":"1986","journal-title":"Dis. Colon Rectum"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"366","DOI":"10.4103\/eus.eus_36_18","article-title":"Has the role of EUS in rectal cancer staging changed in the last decade?","volume":"7","author":"Uberoi","year":"2018","journal-title":"Endosc. Ultrasound"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1055\/s-2002-25292","article-title":"Routine Use of Transrectal Ultrasound in Rectal Carcinoma: Results of a Prospective Multicenter Study","volume":"34","author":"Marusch","year":"2002","journal-title":"Endoscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s002680010151","article-title":"Endorectal ultrasonography and treatment of early stage rectal cancer","volume":"24","author":"Akasu","year":"2000","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1245\/s10434-008-0231-5","article-title":"How Good is Endoscopic Ultrasound in Differentiating Various T Stages of Rectal Cancer? Meta-Analysis and Systematic Review","volume":"16","author":"Puli","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.gie.2011.03.1257","article-title":"EUS and magnetic resonance imaging in the staging of rectal cancer: A prospective and comparative study","volume":"74","author":"Sendino","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/01.mcg.0000225679.06971.bb","article-title":"Olympus Lucera high-resolution vascular ectasia mapping in combination with the type V crypt pattern for the invasive depth estimation and nodal disease estimation in Paris type II colorectal cancers: A comparative prospective analysis to 20 MHz ultrasound","volume":"41","author":"Hurlstone","year":"2007","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.gie.2016.04.034","article-title":"Differential diagnosis of small solid pancreatic lesions","volume":"84","author":"Dietrich","year":"2016","journal-title":"Gastrointest. Endosc."},{"key":"ref_25","first-page":"587806","article-title":"Time-Intensity Curve Parameters in Rectal Cancer Measured Using Endorectal Ultrasonography with Sterile Coupling Gels Filling the Rectum: Correlations with Tumor Angiogenesis and Clinicopathological Features","volume":"2014","author":"Wang","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S131","DOI":"10.1016\/S1590-8658(21)00554-5","article-title":"OC.10.1 Reliability of linear eus in rectal cancer staging: A non-inferiority evaluation between gold standards","volume":"53","author":"Dabizzi","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/his.13975","article-title":"The 2019 WHO classification of tumours of the digestive system","volume":"76","author":"Nagtegaal","year":"2020","journal-title":"Histopathology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.cgh.2015.09.001","article-title":"McKittrick\u2013Wheelock Syndrome","volume":"14","author":"Hsieh","year":"2016","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/ajg.2014.326","article-title":"Polyp Morphology: An Interobserver Evaluation for the Paris Classification Among International Experts","volume":"110","author":"Hazewinkel","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/2050640619845987","article-title":"Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database","volume":"7","author":"Kobayashi","year":"2019","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"575","DOI":"10.7863\/ultra.33.4.575","article-title":"Double-Contrast-Enhanced Sonography for Diagnosis of Rectal Lesions With Pathologic Correlation","volume":"33","author":"Lu","year":"2014","journal-title":"J. Ultrasound Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Binda, C., Coluccio, C., Marocchi, G., Sbrancia, M., and Fabbri, C. (2021). The Role of Contrast-Enhanced Harmonic Endoscopic Ultrasound in Interventional Endoscopic Ultrasound. Medicina, 57.","DOI":"10.3390\/medicina57101085"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1111\/j.1440-1746.2012.07115.x","article-title":"Interobserver agreement in contrast harmonic endoscopic ultrasound","volume":"27","author":"Fusaroli","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1055\/a-1748-8573","article-title":"Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: A new endoscopic approach","volume":"54","author":"Moons","year":"2022","journal-title":"Endoscopy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1111\/j.1463-1318.2011.02830.x","article-title":"A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer","volume":"14","author":"Ashraf","year":"2011","journal-title":"Color. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/13\/2267\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:06:01Z","timestamp":1760126761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/13\/2267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,4]]},"references-count":35,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["diagnostics13132267"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13132267","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,4]]}}}