Advertisement

Magnifying endoscopy for diagnosis of residual/local recurrent gastric neoplasms after previous endoscopic treatment

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

  • 167 Accesses

  • 4 Citations

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2

Abbreviations

APC:

Argon plasma coagulation

CE:

Conventional endoscopy

CME:

Conventional magnifying endoscopy

EME:

Enhanced-magnification endoscopy with acetic acid instillation

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

ME:

Magnifying endoscopy

NBI:

Narrow-band imaging

NBI-ME:

ME with narrow-band imaging

NBI-EME:

Magnifying endoscopy with the combined use of narrow-band imaging and acetic acid instillation

References

  1. 1.

    Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450

  2. 2.

    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

  3. 3.

    Kojima T, Parra-Blanco A, Takahashi H, Fujita R (1998) Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 48:550–555

  4. 4.

    Tada M, Tokiyama H, Nakamura H, Yanai H, Yamaguchi K (1998) Criteria for evaluation of the need for multiple resection after imperfect resection during endoscopic therapy for early gastric cancer [in Japanese with English abstract]. Stomach Intestine 33:1559–1565

  5. 5.

    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection in comparison to endoscopic mucosal resection for early gastric cancer. Gastrointest Endosc 64:877–883

  6. 6.

    Chonan A, Mochizuki F, Ando M, Ando M, Mishima T, Atsumi M, Ozawa T, Fujita N, Yuki T, Ishida K (1998) Macroscopic findings and diagnosis of the depth of invasion of recurrent gastric cancer after EMR [in Japanese with English abstract]. Stomach Intestine 33:1705–1710

  7. 7.

    Nakamura N, Akamatsu T, Yokoyama T, Mochizuki T, Kawamura Y, Tateiwa N, Shinji A, Matsumoto A, Kiyosawa K (2002) Treatment for post EMR remnant lesions: limitation of endoscopic re-treatment. Stomach Intestine 37:1195–1200 [in Japanese with English abstract]

  8. 8.

    Yao K, Oishi T, Matsui T, Yao T, Iwashita A (2002) Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 56:279–284

  9. 9.

    Tajiri H, Doi T, Endo H, Nishida T, Terao T, Hyodo I, Matsuda K, Yagi K (2002) Routine endoscopy using a magnifying endoscope for gastric cancer diagnosis. Endoscopy 34:772–777

  10. 10.

    Otsuka Y, Niwa Y, Ohmiya N, Ando N, Ohashi A, Hirooka Y, Goto H (2004) Usefulness of magnifying endoscopy in the diagnosis of early gastric cancer. Endoscopy 36:165–169

  11. 11.

    Guelrud M, Herrera I, Essenfeld H, Castro J (2001) Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett’s esophagus. Gastrointest Endosc 53:559–565

  12. 12.

    Lambert R, Rey JF, Sankaranarayanan R (2003) Magnification and chromoscopy with the acetic acid test. Endoscopy 35:437–445

  13. 13.

    Toyoda H, Rubio C, Befrits R, Hamamoto N, Adachi Y, Jaramillo E (2004) Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy. Gastrointest Endosc 59:15–21

  14. 14.

    Tanaka K, Toyoda H, Kadowaki S, Kosaka R, Shiraishi T, Imoto I, Shiku H, Adachi Y (2006) Features of early gastric cancer and gastric adenoma by enhanced-magnification endoscopy. J Gastroenterol 41:332–338

  15. 15.

    Tanaka K, Toyoda H, Kadowaki S, Hamada Y, Kosaka R, Matsuzaki S, Shiraishi T, Imoto I, Takei Y (2008) Surface pattern classification by enhanced-magnification endoscopy for identifying early gastric cancers. Gastrointest Endosc 67:430–437

  16. 16.

    Yagi K, Aruga Y, Nakamura A, Sekine A, Umezu H (2005) The study of dynamic chemical magnifying endoscopy in gastric neoplasia. Gastrointest Endosc 62:963–969

  17. 17.

    Gono K, Obi T, Yamaguchi M, Ohyama N, Machida H, Sano Y, Yoshida S, Hamamoto Y, Endo T (2004) Appearance of endoscopic tissue in narrow-band endoscopic imaging. J Biomed Opt 9:568–577

  18. 18.

    Nakayoshi T, Tajiri H, Matsuda K, Kaise M, Ikegami M, Sasaki H (2004) Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 36:1080–1084

  19. 19.

    Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, Yoshida S (2004) Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 36:1094–1098

  20. 20.

    Toyoda H, Tanaka K, Hamada Y, Kosaka Y, Ichiro I (2006) Magnification endoscopic view of an early gastric cancer using acetic acid and narrow-band imaging system. Dig Endosc 18:S41–S43

  21. 21.

    Tanaka K, Toyoda H, Hamada Y, Aoki M, Kosaka R, Noda T, Katsurahara M, Inoue H, Imoto I, Takei Y (2008) Endoscopic submucosal dissection for early gastric cancer using magnifying endoscopy with a combination of narrow band imaging and acetic acid instillation. Dig Endosc 20:150–153

  22. 22.

    Kadowaki S, Tanaka K, Toyoda H, Kosaka R, Imoto I, Hamada Y, Katsurahara M, Inoue H, Aoki M, Noda T, Yamada T, Takei Y, Katayama N (2009) Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods. J Gastroenterol Hepatol 24:1625–1630

  23. 23.

    Japanese Gastric Cancer Association (2010) Japanese classification of gastric carcinoma. Kanehara, Tokyo

  24. 24.

    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kanao H, Kawamura T, Yoshida S, Yoshihara M, Chayama K (2006) Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection. Endoscopy 38:996–1000

  25. 25.

    Yokoi C, Gotoda T, Hamanaka H, Oda I (2006) Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection. Gastrointest Endosc 64:212–218

  26. 26.

    Ohashi A, Niwa Y, Ohmiya N, Miyahara R, Itoh A, Hirooka Y, Goto H (2005) Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions. Endoscopy 37:1215–1219

Download references

Disclosures

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.

Author information

Correspondence to Kyosuke Tanaka.

Additional information

R. Kosaka and K. Tanaka contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

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)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

Keywords

  • Endoscopy
  • Stomach neoplasms
  • Recurrence
  • Residual neoplasm
  • Acetic acid