Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancers for magnifying endoscopy with narrow-band imaging: endoscopic submucosal dissection cases

Introduction: Gastric cancer is one of the highly malignant gastrointestinal cancers and the third leading cause of cancer death. In the last decade, early gastric cancer (EGC) has been reported by using narrow-band imaging (NBI) magnifying endoscopy. Advances in endoscopic techniques, such as endoscopic submucosal dissection (ESD), have enabled the en bloc resection of these EGC. Although ESD is performed for early gastric cancer, there are still many difficult problems in technique of this procedure. The difficulty of gastric ESD depends on the size and location of a tumor, presence of severe submucosal fibrosis, presence of ulceration... We report a case of our successful ESD by using Clutch cutter and IT knife 2 in treatment of EGC with severe submucosal fibrosis. Case presentation: A 62-year-old man felt an epigastric discomfort two months ago. The narrow-band imaging (NBI) magnifying endoscopy revealed a suspected early gastric cancer type 0 - IIa + IIc (Japanese classification of early gastrointestinal cancers) at the incisura angularis, the size of this lesion was 15 mm in diameter, and pathological result of endoscopic biopsy was a well-differentiated adenocarcinoma. ESD was performed and we found there was severe submucosal fibrosis which was dissected safer and faster by using Clutch cutter and IT knife 2. There were no complications such as severe bleeding and perforation. The size of resected specimen was 60 x 35 mm and the time of procedure was 150 minutes. After ESD, the pathological result was a well differentiated adenocarcinoma, pT1a, UL(-), LY(-), V(-), no cancer cell in vertical and horizontal margins. The healing time of ESD-induced ulcer was 5 weeks without local recurrence. Conclusion: Through this case, we aim to emphasize the importance of using Clutch cutter and IT knife 2 as a modified technique which makes ESD a safe procedure in treatment of EGC with severe submucosal fibrosis.

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Diagnosis of undifferentiated type early gastric cancers by magnification endoscopy with narrow-band imaging

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.2011.06730.x ◽

2011 ◽

Vol 26 (8) ◽

pp. 1262-1269 ◽

Cited By ~ 39

Author(s):

Kazuhisa Okada ◽

Junko Fujisaki ◽

Akiyoshi Kasuga ◽

Masami Omae ◽

Toshiaki Hirasawa ◽

...

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Gastric Cancers ◽

Magnification Endoscopy ◽

Undifferentiated Type

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Usefulness of Magnifying Endoscopy with Narrow-Band Imaging for Diagnosing Mixed Poorly Differentiated Gastric Cancers

Digestion ◽

10.1159/000517970 ◽

2021 ◽

pp. 1-8

Author(s):

Mitsuko Inuyama ◽

Yusuke Horiuchi ◽

Noriko Yamamoto ◽

Shoichi Yoshimizu ◽

Akiyoshi Ishiyama ◽

...

Keyword(s):

Endoscopic Treatment ◽

Narrow Band ◽

Narrow Band Imaging ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Magnifying Endoscopy ◽

Combination Method ◽

Detection Rates ◽

Undifferentiated Type ◽

Poorly Differentiated

Introduction: Curative rates of endoscopic treatment for undifferentiated-type early gastric cancer (EGC), particularly mixed poorly differentiated adenocarcinoma (MIXED-POR), are lower than those of endoscopic treatment for the differentiated type. Magnifying endoscopy with narrow-band imaging (ME-NBI) is useful for diagnoses of the histological type. This study aimed to investigate the detection rates of MIXED-POR among undifferentiated-type EGCs using biopsy and ME-NBI in order to improve curative rates through endoscopic treatment. Methods: We analyzed 267 lesions initially subjected to endoscopic submucosal resection (ESD) and histologically diagnosed as undifferentiated-type EGCs between July 2005 and December 2016 at our hospital. We obtained written informed consent from all participants. Biopsy and ME-NBI findings were compared to distinguish pure signet ring cell carcinoma (PURE-SIG) and MIXED-POR. ME-NBI findings were divided into 2 categories depending on the presence of irregular vessels. Results of biopsy and ME-NBI (combination method) were also analyzed, and detection rates of MIXED-POR and PURE-SIG were evaluated in terms of sensitivity, specificity, and accuracy. Results: Overall, 114 lesions were analyzed. Fifty-eight lesions (50.9%) were identified as MIXED-POR. With biopsy, the detection rate of MIXED-POR was significantly lower than that of PURE-SIG (p < 0.0001). ME-NBI detected significantly more MIXED-POR with irregular vessels than PURE-SIG (p < 0.0001). The combination method could detect significantly more MIXED-POR than PURE-SIG (p < 0.0001). The sensitivity and accuracy for MIXED-POR diagnosis were significantly higher with the combination method than with biopsy alone (p < 0.0001). Discussion/Conclusion: Combining biopsy and ME-NBI improved the accuracy of pretreatment diagnosis before ESD in undifferentiated-type cancer.

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