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CLASSIFICATION
Classification
Japanese Type 0 vs Paris
Type 0 macroscopic types in the Japanese rules for the esophagus, stomach, and colorectum. The symbols match Paris, but 0-I subtypes, the 0-I versus 0-IIa cut-off, mixed-type notation, and whether 0-III is used differ by organ and document. Advanced types 1–5 are not covered.
Classification overview
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0-I protruding
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0-Ip
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0-Is
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0-II superficial
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0-IIa
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0-IIb
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0-IIc
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0-III excavated
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0-III
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0-IIc+III
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0-III+IIc
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Mixed type
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0-IIc+IIa
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0-IIa+IIc
Protruding
0-I
Protruding
Morphology
A frankly protruding lesion. The stomach does not split by stalk.
Paris
0-I is split into 0-Ip and 0-Is. Paris uses those subtypes in the stomach too.
Stomach
The formal type. The 0-I versus 0-IIa cut-off is about 2.5 mm above the adjacent mucosa (same as Paris columnar epithelium).
Note: Checked in the 15th Japanese edition. The gastric cut-off is aligned with Paris at 2.5 mm. The rule text is not quoted.
0-Ip
Pedunculated
Morphology
A protruding lesion with a distinct stalk.
Paris
In the table (0-Ip).
Colorectum
A formal subtype (0-Ip).
Esophagus
0-Ip. Subpedunculated lesions may be grouped here.
0-Isp
Subpedunculated
Morphology
A constricted protrusion without a long stalk.
Paris
Not in the 2003/2005 table. Treated as 0-Is as clinically unhelpful.
Colorectum
A formal subtype (0-Ip / 0-Isp / 0-Is).
Esophagus
No separate Isp field. Grouped with Ip.
Note: A colorectal 0-Isp is Paris 0-Is. Later schematics often put Isp back, which is easy to confuse with the Paris table.
0-Is
Sessile
Morphology
A frankly protruding lesion without a stalk.
Paris
In the table. In columnar epithelium (stomach and colorectum), at least about 2.5 mm above the adjacent mucosa (closed biopsy forceps). Esophageal squamous epithelium uses 1.2 mm. Below that is 0-IIa.
Colorectum
A frankly polypoid mass. No millimetre cut-off.
Esophagus
Sessile, with a broad base more conspicuous than height. No forceps millimetre rule.
Note: A 3–4 mm broad sessile elevation or LST-G granules is often 0-IIa in Japanese colorectal notes and 0-Is if Paris is applied strictly.
Superficial
0-IIa
Slightly elevated
Morphology
A low elevation above the adjacent mucosa.
Paris
Less than 2.5 mm in columnar epithelium, less than 1.2 mm in esophageal squamous epithelium. Above that is 0-Is.
Colorectum
A low elevation. Qualitative; no millimetre cut-off. Lateral spread ≥10 mm is called LST and is not a macroscopic type.
Stomach
Less than about 2.5 mm above the adjacent mucosa. Above that is 0-I. Same as Paris columnar epithelium.
Esophagus
Only slightly elevated. The 2.5 mm forceps rule is not written.
Note: The other side of the same 0-Is cut-off. This is the main label swap on the same lesion.
0-IIb
Flat
Morphology
Flat, within the normal mucosal relief.
Paris
In the table. Very rare in the colorectum.
Colorectum
Used. Rare.
Stomach
Used.
Esophagus
Used.
Note: Almost the same in all four documents. Little practical difference.
0-IIc
Slightly depressed
Morphology
A shallow depression or erosion.
Paris
In the table. Deeper ulcers are 0-III (about 1.2 mm in columnar epithelium, 0.5 mm in esophageal squamous epithelium).
Colorectum
Superficial depressed. 0-III was deleted, so a deep ulcer type is not used.
Stomach
Superficial depressed. Frankly deep lesions are 0-III.
Esophagus
Superficial depressed. Frankly deep lesions are 0-III.
Mixed
Mixed type
Combined components
Morphology
Two or more types combined. The usual pairs are 0-IIa+IIc and 0-IIc+IIa.
Paris
Defined by shape. A relative depression (floor still above the adjacent mucosa) is 0-IIa+IIc. 0-IIc+IIa is mainly depressed, with a rim or partial elevation.
Colorectum
The rule text writes the larger-area component first, joined by +. The atlas does not follow area: 0-IIc+IIa has a depressed surface below the mucosa (a conspicuous reactive rim); 0-IIa+IIc is a flat elevation whose depression is still above the mucosa (relative depression).
Stomach
Write the larger-area component first, joined by +.
Esophagus
Area-first. The component that suggests deeper invasion is placed in quotation marks (example: 0-IIc+“0-Is”). If an advanced type is mixed in, write that type first.
Note: The atlas height rule (IIc+IIa is the lower “first floor”; IIa+IIc is a relative depression on the “second floor”) is a colorectal atlas note only. The rule texts are area-first. Paris is shape.
Excavated
0-III
Deep excavation
Morphology
A frankly deep depression or ulcer.
Paris
In the table. Depth separates it from IIc. A note says not to apply it in the colorectum (mainly Barrett and stomach). 0-IIc+III / 0-III+IIc also exist.
Colorectum
Almost never used, so it was deleted. Current Type 0 is 0-I and 0-II only.
Stomach
0-III (excavated) is used. Mixed forms with IIc (0-IIc+III) also exist.
Esophagus
0-III (superficial excavated) is used. Mixed forms with IIc also exist.
Note: In the colorectum, Paris and the Japanese rules agree that 0-III is almost never used. In the stomach and esophagus it is a formal Japanese type. The Paris page keeps 0-III because the table is organ-wide, not because colorectal practice uses it.
Reference
Original article
Endoscopic Classification Review Group. Endoscopy 2005;37:570-578
Related study
The Paris endoscopic classification of superficial neoplastic lesions. Gastrointest Endosc 2003;58:S3-S43
Official link
JSCCR. J Anus Rectum Colon 2019;3:175-195 (9th Japanese ed., English)
Official link
JGCA. Gastric Cancer 2011;14:101-112 (3rd English ed.)
Official link
JES. Esophagus 2024 (12th ed., Part I)
Japanese reference
大腸癌研究会. 大腸癌取扱い規約 第9版. 金原出版; 2018
Japanese reference
日本胃癌学会. 胃癌取扱い規約 第15版. 金原出版; 2017
Japanese reference
日本食道学会. 食道癌取扱い規約 第12版. 金原出版; 2022
Japanese reference
JSCCR Japanese classification (society page)
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