Incomplete resection of gastric neoplasms by endoscopic treatment could lead to residual/local recurrence, which may be difficult to identify. This study aimed to evaluate the usefulness of magnifying endoscopy for identifying and demarcating residual/local recurrent gastric neoplasms after endoscopic treatment.
Between December 2004 and November 2010, magnifying endoscopy was performed in 15 patients with residual/local recurrent gastric neoplasms. All patients underwent conventional magnifying endoscopy (CME) and enhanced-magnification endoscopy with acetic acid instillation (EME) after conventional endoscopy (CE). Eleven patients additionally underwent magnifying endoscopy using narrow-band imaging (NBI-ME) and a combination of narrow-band imaging and acetic acid instillation (NBI-EME). For each procedure, it was recorded whether the location and circumferential demarcation of the lesions were identified. All lesions were resected by endoscopic submucosal dissection.
Eleven lesions were identified using CE. However, two and four additional lesions were identified using CME and EME, respectively. In 11 cases, NBI-ME and NBI-EME were performed and all lesions were identified. Three lesions, which were identified by CME, were not demarcated circumferentially. All 15 lesions were well demarcated by EME and 11 by NBI-ME and NBI-EME. Of the resected specimens, histopathology indicated that ten lesions were differentiated tubular adenocarcinomas and five lesions were adenomas. The histopathological diagnosis of the location and demarcation of all neoplasms corresponded to endoscopic findings.
Magnifying endoscopy techniques (CME, EME, NBI-ME, and NBI-EME) may be useful for identifying and demarcating residual/local recurrent gastric neoplasms after previous endoscopic treatment.
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Argon plasma coagulation
Conventional magnifying endoscopy
Enhanced-magnification endoscopy with acetic acid instillation
Endoscopic mucosal resection
Endoscopic submucosal dissection
ME with narrow-band imaging
Magnifying endoscopy with the combined use of narrow-band imaging and acetic acid instillation
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Drs. Ryo Kosaka, Kyosuke Tanaka, Shunsuke Tano, Reiko Takayama, Kenichiro Nishikawa, Yasuhiko Hamada, Hideki Toyoda, Katsuhito Ninomiya, Masaki Katsurahara, Hiroyuki Inoue, Noriyuki Horiki, Naoyuki Katayama, and Yoshiyuki Takei have no conflicts of interest or financial ties to disclose.
R. Kosaka and K. Tanaka contributed equally to this work.
Electronic supplementary material
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Video: Locally recurrent early cancer is located near the post-treatment scar in the gastric angle. However, it could not be identified with conventional endoscopy and conventional magnifying endoscopy. By using magnifying endoscopy with narrow-band imaging, the lesion was clearly revealed as a brownish area. The lesion has an irregular surface pattern with irregular microvessels and is well-demarcated. With 1.5% acetic acid instillation, the gastric mucosa becomes white. Enhanced-magnification endoscopy with acetic acid instillation reveals a clearly irregular surface pattern and the lesion was well-demarcated. Combination with narrow-band imaging provides clearer views (WMV 16232 kb)
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Kosaka, R., Tanaka, K., Tano, S. et al. Magnifying endoscopy for diagnosis of residual/local recurrent gastric neoplasms after previous endoscopic treatment. Surg Endosc 26, 2299–2305 (2012). https://doi.org/10.1007/s00464-012-2178-7
- Stomach neoplasms
- Residual neoplasm
- Acetic acid