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  • Print publication year: 2009
  • Online publication date: March 2010

3 - Endoscopy in the diagnosis and treatment of gastric cancer



Because of its lethal prognosis when advanced, early detection and resection of gastric cancer remains the best means of treating this neoplasm. In the hope of detecting this cancer in its earliest possible form, chromoendoscopy with indigo carmine spray was developed. This technique enhances fine surface structures and color contrast of the mucosa, resulting in improved diagnostic accuracy. Since the late 1990s, advances in biomedical optics have been applied to overcome the limitations of chromoendoscopy for detecting various gastrointestinal (GI) diseases. Endoscopists require meticulous endoscopic technique and considerable clinical experience in diagnosing early gastric cancer (EGC). New and improved endoscopic modalities are being developed for screening high-risk patients.

The flexible spectral imaging color enhancement (FICE) system was introduced in 2005 as a novel image-processing tool for video endoscopy. FICE enhances the contrast of the gastric mucosal surface without the use of dyes. Because image processing can be executed using the endoscope processor, FICE does not require modification of the light source as does the narrow band imaging (NBI) system. Additionally, FICE provides optimal band images with the same light intensity as the conventional endoscope. Indeed, FICE can facilitate detection of changes in EGC without magnification and can accurately confirm the diagnosis of cancer with 40-fold magnification.

After an endoscopically detailed examination has been performed and the patient meets inclusion criteria, endoscopic therapy of EGC can be performed with the expectation of a complete cure.

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