score/[id]

CLASSIFICATION

Classification

Paris classification (superficial morphology)

Endoscopic Type 0 morphology of superficial neoplasia (mucosa to submucosa) in the esophagus, stomach, and colorectum: protruding (0-I), flat (0-II), and excavated (0-III). 0-Isp is not in the 2003/2005 Paris table.

Classification overview

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0-I · Protruding

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0-Ip · Pedunculated

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0-Is · Sessile

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0-II · Nonprotruding and nonexcavated

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0-IIa · Slightly elevated

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0-IIb · Completely flat

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0-IIc · Slightly depressed

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0-IIc+IIa · Depressed with elevated rim

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0-IIa+IIc · Elevated with central depression

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0-III · Excavated family

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0-III · Excavated (ulcer)

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0-IIc+III · Depressed with central ulcer

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0-III+IIc · Ulcer with depressed margin

Protruding

0-Ip

Pedunculated

GI Calc, Not original, CC BY

Category

Protruding

Morphology

Pedunculated

Cut-off

Protruding vs slightly elevated: 2.5 mm (columnar epithelium; closed biopsy forceps) or 1.2 mm (esophageal squamous epithelium)

0-Is

Sessile

GI Calc, Not original, CC BY

Category

Protruding

Morphology

Sessile

Cut-off

Elevation from the adjacent mucosa is at least 2.5 mm in columnar epithelium (1.2 mm in the esophagus)

Note: Sessile colorectal lesions have a relatively high SM-invasion rate (2005 Table 4: 34% for colorectal 0-Is).

Nonprotruding

0-IIa

Slightly elevated

GI Calc, Not original, CC BY

Category

Nonprotruding and nonexcavated

Morphology

Slightly elevated

Cut-off

Elevation less than 2.5 mm from the adjacent mucosa in columnar epithelium (less than 1.2 mm in the esophagus)

0-IIb

Completely flat

GI Calc, Not original, CC BY

Category

Nonprotruding and nonexcavated

Morphology

Completely flat

Note: Very rare in the colorectum.

0-IIc

Slightly depressed

GI Calc, Not original, CC BY

Category

Nonprotruding and nonexcavated

Morphology

Slightly depressed

Cut-off

Depression less deep than 1.2 mm in columnar epithelium (0.5 mm in esophageal squamous epithelium). Deeper lesions are excavated (0-III).

Note: Depressed lesions have a high SM-invasion risk (2005 Table 4: 61% for colorectal 0-IIc).

0-IIc+IIa

Depressed + elevated rim

GI Calc, Not original, CC BY

Category

Elevated and depressed types

Morphology

Most of the surface is depressed; elevation is present in a segment of the lesion at the periphery

0-IIa+IIc

Elevated + central depression

GI Calc, Not original, CC BY

Category

Elevated and depressed types

Morphology

There is a central depression in a globally elevated lesion. The central depression is surrounded by an elevated ring.

Note

When the level of the depression is higher than the mucosa adjacent to the lesion, it is a relatively depressed lesion.

Excavated

0-III

Excavated (ulcer)

GI Calc, Not original, CC BY

Category

Excavated

Morphology

Ulcer

Note: Almost never seen in the colorectum.

0-IIc+III

Depressed + central ulcer

GI Calc, Not original, CC BY

Category

Excavated and depressed types

Morphology

A depressed lesion with a central ulcer

0-III+IIc

Ulcer + depressed margin

GI Calc, Not original, CC BY

Category

Excavated and depressed types

Morphology

An ulcer with short depressed margins

Kim 2025, Fig. 2, Not original, CC BY-NC

GI Calc, Not original, CC BY

More reference figures

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Reference

Original article

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005;37:570-578. The Paris endoscopic classification of superficial neoplastic lesions. Gastrointest Endosc 2003;58:S3-S43

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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.

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