Effective optical identification of type “0-IIb” early gastric cancer with narrow band imaging magnification endoscopy, successfully treated by endoscopic submucosal dissection

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Effective optical identification of type “0-IIb” early gastric cancer with narrow band imaging magnification endoscopy, successfully treated by endoscopic submucosal dissection (EN)

Ikeda, Haruo; Digestive Disease Center, Showa University Northern Yokohama Hospital
Inoue, Haruhiro; Digestive Disease Center, Showa University Northern Yokohama Hospital
Santi, Grace; Digestive Disease Center, Showa University Northern Yokohama Hospital
Hamatani, Shigeharu; Department of Pathology, Showa University Northern Yokohama Hospital
Eleftheriadis, Nikolas; Digestive Disease Center, Showa University Northern Yokohama Hospital
Onimaru, Manabu; Digestive Disease Center, Showa University Northern Yokohama Hospital
Yoshida, Akira; Digestive Disease Center, Showa University Northern Yokohama Hospital
Maselli, Roberta; Digestive Disease Center, Showa University Northern Yokohama Hospital
Kudo, Shin-ei; Digestive Disease Center, Showa University Northern Yokohama Hospital

Background Endoscopic submucosal dissection (ESD) is currently considered the minimal invasive endoscopic treatment for early gastric cancer. Most superficial gastric neoplastic  lesions are depressed type ”0-IIc” (70-80%), while totally flat, classified as type ”0-IIb” early gastric cancer, is rarely reported (0.4%). The aim of the present study was to assess the efficacy of narrow band imaging (NBI) magnification endoscopy in identifying type “0-IIb” early gastric cancer and ESD treatment with curative intention.Methods Twelve of 615 (2%) patients (10 males, median 72 years), treated by ESD at our center, were diagnosed as type “0-IIb” gastric cancer. Ten had exclusively type “0-IIb”, while two had combined types “0-IIb+IIc” and “0-IIa+IIb” gastric cancer. Initial diagnosis was made during screening gastroscopy, while NBI magnification endoscopy combined with indigo-carmine chromoendoscopy were also used.Results White light endoscopy showed only superficial redness. One patient with signet-ring carcinoma showed whitish appearance. Indigo-carmine chromoendoscopy showed better visualization, while NBI magnification endoscopy revealed abnormal mucosal microsurface and microvascular findings which enabled border marking. ESD with curative intention was completed without complications. Histological examination showed complete (R0) resection, in 10 patients (83%). One patient with positive margins received additional surgery (8%). Mean procedure time was 149 (range 60-190) min. One to six years post-ESD all patients remain alive.Conclusions ESD is considered a safe and effective curative treatment for type “0-IIb” gastric cancer, resulting in long-term disease-free survival. NBI magnification endoscopy is effective for accurate optical identification and border marking of type “0-IIb” early gastric cancer.Keywords Endoscopic submucosal dissection, narrow band imaging magnification endoscopy, type “0-IIb” early gastric cancerAnn Gastroenterol 2015; 28 (1): 72-80 (EN)

Ελληνική Γαστροεντερολογική Εταιρία (EL)
Hellenic Gastroenterologiki Company (EN)

2015-01-05


Annals of Gastroenterology (EN)

Annals of Gastroenterology; Volume 28, No 1 (2015); 72 (EN)



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