Abstract
In clinical practice, it is often found that gastric lesions diagnosed as adenomas by pretreatment biopsy prove to be gastric cancers after endoscopic resection. Magnifying endoscopy with narrow-band imaging is a novel and excellent technique, and it helps discriminate gastric cancers from lesions and adenomas. This article is part of an expert video encyclopedia.
Keywords
Video Related to this Article
Endoscopic Image of Gastric Adenoma: Magnifying Endoscopy with Narrow-Band Imaging
Materials
- •Endoscope: GIF-H260Z, Olympus Medical Systems Corporation, Tokyo, Japan.
- •Electronic endoscopy system: EVIS LUCERA SPECTRUM, Olympus Medical Systems Corporation, Tokyo, Japan.
Background and Endoscopic Procedures
There is no consensus on the management of gastric lesions diagnosed as adenomas (Vienna classification category 3) by forceps biopsy. However, it is often found that there is discrepancy between pretreatment diagnosis and pathological diagnosis after endoscopic resection.
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Therefore, it is important to discriminate cancers from adenomas endoscopically in lesions diagnosed as adenomas in pretreatment forceps biopsy.Magnifying endoscopy with narrow-band imaging (ME-NBI) enables us to see the microvascular (MV) and microsurface (MS) architecture clearly on the gastric mucosa, and the diagnostic criteria based on MV and MS pattern (vascular surface classification by Yao et al.
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) makes it possible to discriminate cancers from various gastric lesions.The efficacy of ME-NBI in discriminating cancers from gastric lesions diagnosed as adenomas by forceps biopsy was reported.
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In clinical practice, when a detailed endoscopic examination of such a lesion was performed, only a button on the handle of the endoscope was pushed and the zooming lever was turned. If an adenomatous lesion diagnosed by forceps biopsy shows irregular MV or MS pattern, the lesion is most likely a cancerous lesion, and it should be resected endoscopically.Key Learning Points/Tips and Tricks
- •A soft black hood (MB-46, Olympus, Tokyo, Japan) should be mounted on the tip of the endoscope to avoid injuring gastric mucosa.2
- •Before magnifying endoscopy, wash the target lesion with sufficient water with dimethicone to remove mucus.
- •Observe the lesion at the highest magnification when judging whether MV pattern is regular or irregular.
- •Gentle suction should be used when it is difficult to approach the target lesion.
- •When MV pattern is difficult to see, irregular white opaque substance is a useful sign suggestive of cancer.4
Scripted Voiceover
Tabled
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| Time (min:sec) | Voiceover text |
|---|---|
| 00:00 | This is a 72-year-old Japanese male patient, referred to us for endoscopic diagnosis and treatment of a gastric lesion diagnosed as adenoma by forceps biopsy. Its diameter is more than 30 mm. The diameter is suggestive of an early gastric cancer. |
| 00:21 | However, magnifying endoscopy with narrow-band imaging reveals no irregular microvascular or microsurface pattern on the tumor. At the highest magnification, microvessels show symmetric distribution and regular arrangement, which indicate that the lesion is not a cancer. |
| 00:45 | After endoscopic resection and histological evaluation, the final diagnosis was a low-grade adenoma. |
| 00:57 | This is a 65-year-old Japanese male patient referred to our hospital. According to past endoscopic examination at another hospital, a slightly reddish area was detected in the antrum and diagnosed as low-grade adenoma by forceps biopsy. However, it was a very faint lesion and was almost indiscernible. |
| 01:25 | Magnifying endoscopy with narrow-band imaging detected a well-demarcated area with irregular microvessels. This finding strongly suggested the possibility of cancer. |
| 01:51 | We performed ESD for the lesion. The margin of the lesion could be determined based on the magnifying endoscopic finding. The pathological diagnosis was a well-differentiated adenocarcinoma confined to the mucosa. |
References
- Histologic Diagnosis Based on Forceps Biopsy is not Adequate for Determining Endoscopic Treatment of Gastric Adenomatous Lesions.Endoscopy. 2010; 42: 620-626
- Magnifying Endoscopy for Diagnosing and Delineating Early Gastric Cancer.Endoscopy. 2009; 41: 462-467
- Magnifying Endoscopy with Narrow-Band Imaging Helps Determine the Management of Gastric Adenomas.Gastric Cancer. 2012; 15: 414-418
- White Opaque Substance Within Superficial Elevated Gastric Neoplasia as Visualized by Magnification Endoscopy with Narrow-Band Imaging: A New Optical Sign for Differentiating Between Adenoma And Carcinoma.Gastrointest. Endosc. 2008; 68: 574-580
Article info
Publication history
Accepted:
July 8,
2012
Received in revised form:
June 1,
2012
Received:
June 1,
2012
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