Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video)

doi:10.1016/j.gie.2011.09.005

Gastrointestinal Endoscopy

Volume 74, Issue 6, December 2011, Pages 1259-1267

Presented at the 18th United European Gastroenterology Week (Endoscopy 2010;42[Suppl I] A99).

https://doi.org/10.1016/j.gie.2011.09.005 Get rights and content

Background

Magnifying endoscopy (ME) with narrow-band imaging (NBI) may allow reliable delineation of the horizontal extent of early gastric cancers before endoscopic submucosal dissection (ESD). However, the advantages of ME with NBI over standard endoscopy with dye spraying (chromoendoscopy [CE]) have yet to be elucidated.

Objective

To investigate the usefulness and limitations of ME with NBI when CE is unsuccessful for determining the horizontal extent of early gastric cancer.

Design

Case series.

Setting

Single tertiary referral center.

Materials

Series of 350 consecutive early gastric cancers resected en bloc using ESD.

Intervention

ME with NBI for cancers with unclear margins by CE.

Main Outcome Measurements

The rate of successful delineation by ME with NBI for cancers that had demonstrated unclear margins using CE.

Results

The proportion of cancers showing unclear margins using CE was 18.9% (66/350). Of these, 62 of 66 cancers were examined using ME with NBI, with the entire margins successfully delineated in 72.6% (45/62) of the lesions that had shown unclear margins using CE. The success rate was 0% for undifferentiated cancers, significantly lower than that for differentiated lesions (P < .00001).

Limitations

Even by using ME with NBI, endoscopic delineation remains difficult for undifferentiated lesions.

Conclusions

ME with NBI is an excellent modality for identifying the entire margin of early gastric cancers, when the margins are unclear using CE.

Section snippets

Methods

A total of 356 early gastric cancers from 327 patients that had been resected by ESD between August 2005 and December 2009 at the Department of Gastroenterology, Fukuoka University Chikushi Hospital were included in this study. According to the histopathological investigation of the resected specimens, we excluded 6 early gastric cancers for which we could not evaluate the horizontal extent histopathologically because of piecemeal resection. Accordingly, we analyzed 350 lesions in 321 patients

Advantage of ME with NBI over CE for determining the margins of the lateral extent of early gastric cancer

The numbers of cancers with clear margins by CE and cancers with unclear margins by CE were 285 and 65, respectively. According to the histopathological reassessment, 1 of 285 cancers with clear margins by CE demonstrated horizontal margins that were positive for cancerous tissue. Accordingly, the proportion of cancer with successful delineation by CE was 81.1% (284/350), whereas that with unsuccessful delineation by CE was 18.9% (66/350) (Fig. 5).

Of the 66 lesions with unsuccessful delineation

Discussion

CE is extremely effective in the preoperative determination of the horizontal extent of early gastric cancers because it can identify subtle changes in the gastric mucosal epithelium associated with the lateral spread of cancer.8, 15 In this study, however, when we conducted a strict evaluation of the entire margins of early gastric cancers by using CE in subjects undergoing ESD, we found that the margins of the lateral extent were unclear in 18.9% of lesions. A recent study at another

Acknowledgments

The English used in this article was revised by K. Miller (Royal English Language Centre, Fukuoka, Japan).

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: DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

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Original articleClinical endoscopyUsefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video)

Background

Objective

Design

Setting

Materials

Intervention

Main Outcome Measurements

Results

Limitations

Conclusions

Section snippets

Methods

Advantage of ME with NBI over CE for determining the margins of the lateral extent of early gastric cancer

Discussion

Acknowledgments

Clin Gastroenterol Hepatol

Gastrointest Endosc

Endoscopic mucosal resection for treatment of early gastric cancer

Gut

Aggressive endoscopic mucosal resection in the upper GI tract: hook knife EMR method

Min Invas Ther Allied Technol

Endoscopic submucosal dissection with the hook knife

Stomach Intestine

Incompletely resected case under the extended indication of endoscopic submucosal dissection for early gastric cancer

Stomach Intestine

Current status of endoscopic submucosal dissection in early stomach cancer

Stomach Intestine

Original article
Clinical endoscopy
Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video)