Table 1.

The revised Vienna classification of gastrointestinal epithelial neoplasia

Category	Diagnosis	Clinical management
1	Negative for neoplasia	Optional follow up
2	Indefinite for neoplasia	Follow up
3	Mucosal low grade neoplasia	Endoscopic resection or follow up*
	Low grade adenoma
	Low grade dysplasia
4	Mucosal high grade neoplasia	Endoscopic or surgical local resection*
	4.1 High grade adenoma/dysplasia
	4.2 Non-invasive carcinoma (carcinoma in situ)
	4.3 Suspicious for invasive carcinoma
	4.4 Intramucosal carcinoma
5	Submucosal invasion by carcinoma	Surgical resection*

*Choice of treatment will depend on the overall size of the lesion; the depth of invasion as assessed endoscopically, radiologically, or ultrasonographically; and on general factors such as the patient's age and comorbid conditions. For gastric, oesophageal, and non-polypoid colorectal well and moderately differentiated carcinomas showing only minimal submucosal invasion (sm1) without lymphatic involvement, local resection is sufficient. Likewise, for polypoid colorectal carcinomas with deeper submucosal invasion in the stalk/base but without lymphatic or blood vessel invasion, complete local resection is considered adequate treatment.