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

3 - Endoscopy in the diagnosis and treatment of gastric cancer

Summary

Introduction

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.

References
Triantafillidis, JK and Cheracakis, P.Diagnostic evaluation of patients with EGC – a literature review. Hepatogastroenterology 2004; 51: 618–24.
Miyake, Y, Sekiya, T, Kubo, Set al. A new spectrophotometer for measuring the spectral reflectance of gastric mucous membrane. J Photogr Sci 1989; 37: 134–8.
Shiobara, T, Zhou, H, Haneishi, Net al. Improved color reproduction of electronic endoscopes. J Imaging Sci Technol 1996; 40: 494–501.
Tsumura, N, Tanaka, T, Haneishi, Het al. Optimal design of mosaic color electronic endoscopes. Opt Commun 1998; 145: 27–32.
Shiobara, T, Haneishi, N, and Miyake, Y.Color correction for colorimetric color reproduction in an electronic endoscope. Opt Commun 1995; 114: 57–63.
Nishi, M, Omori, Y, and Miwa, K (eds.). Japanese Classification of Gastric Carcinoma, 1st edn. Tokyo: Kanehara & Co. Ltd./Japanese Research Society for Gastric Cancer, 1995.
Onodera, H, Tokunaga, A, Yoshiyuki, Tet al. Surgical outcome of 483 patients with EGC: prognosis, postoperative morbidity and mortality, and gastric remnant cancer. Hepatogastroenterology 2004; 51: 82–5.
Inoue, K, Tobe, T, Kan, Net al. Problems in the definition and treatment of EGC. Br J Surg 1991; 78: 818–21.
Maehara, Y, Orita, H, Okuyama, Tet al. Predictors of lymph node metastasis in EGC. Br J Surg 1992; 79: 245–7.
Seto, Y, Nagawa, H and Muto, T.Impact of lymph node metastasis on survival with EGC. World J Surg 1997; 21: 186–9.
Sagawa, T, Takayama, T, Oku, Tet al. Argon plasma coagulation for successful treatment of EGC with intramucosal invasion. Gut 2003; 52: 334–9.
Murakami, M, Nishino, K, Inoue, Aet al. Argon plasma coagulation for the treatment of EGC. Hepatogastroenterology 2004; 51: 1658–61.
Gotoda, T, Yamamoto, H, and Soetikno, RM.Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006; 41: 929–42.
Yamamoto, H.Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 2005; 37: 764–8.
Yamamoto, H.Endoscopic submucosal dissection of early cancers and large flat adenomas. Clin Gastroenterol Hepatol 2005; 3 Suppl 1: S67–70.
,Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma, second English edition. Gastric Cancer 1998; 1: 10–24.
The Paris Endoscopic Classification of Superficial Neoplastic Lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 Suppl 6: S3–43.
Yamamoto, H.Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms. Nat Clin Pract Gastroenterol Hepatol 2007; 4: 511–20.
Osawa, H, Yoshizawa, M, Yamamoto, Het al. Optimal band imaging system can facilitate detection of change in depressed type EGC. Gastrointest Endosc 2008; 67: 226–34.
Yoshizawa, M, Osawa, H, Yamamoto, Het al. Newly developed optimal band imaging system for the diagnosis of early gastric cancer. Dig Endosc 2008; 20(4): 194–7.
Yao, K, Oishi, T, Matsui, Tet al. Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 2002; 56: 279–84.
Sumiyama, K, Kaise, M, Nakayoshi, Tet al. Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer. Gastrointest Endosc 2004; 60: 79–84.
Sano, T, Okuyama, Y, Kobori, Oet al. EGC: endoscopic diagnosis of depth of invasion. Dig Dis Sci 1990; 35: 1340–4.
Yanai, H, Matsumoto, Y, Harada, Tet al. Endoscopic ultrasonography and endoscopy for staging depth of invasion in EGC: a pilot study. Gastrointest Endosc 1997; 46: 212–16.
Akahoshi, K, Misawa, T, Fujishima, Het al. Preoperative evaluation of gastric cancer by endoscopic ultrasound. Gut 1991; 32: 479–82.
Akahoshi, K, Chijiwa, Y, Hamada, Set al. Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe. Gastrointest Endosc 1998; 48: 470–6.
Matsumoto, Y, Yanai, H, Tokiyama, Het al. Endoscopic ultrasonography for diagnosis of submucosal invasion in EGC. J Gastroenterol 2000; 35: 326–31.
Adachi, Y, Shiraishi, N and Kitano, S.Modern treatment of EGC: review of the Japanese experience. Dig Surg 2002; 19: 333–9.
Kunisaki, C, Shimada, H, Takahashi, Met al. Prognostic factors in EGC. Hepatogastroenterology 2001; 48: 294–8.
Kumai, K.Indications of endoscopic submucosal dissection for early gastroenterological cancer: advantages and disadvantages (in Japanese with English abstract). Endosc Dig 2004; 16: 703–8.
Ono, H, Kondo, H, Gotoda, Tet al. Endoscopic mucosal resection for treatment of EGC. Gut 2001; 48: 225–9.
Yamamoto, H, Kawata, H, Sunada, Ket al. Successful en-bloc resection of large superficial tumours in the stomach and colon using sodium hyaluronate and small-calibre-tip transparent hood. Endoscopy 2003; 35: 690–4.
Yamamoto, H, Sekine, Y, Higashizawa, Tet al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc 2001; 54: 629–32.
Oyama, T and Kikuchi, Y.Aggressive endoscopic mucosal resection in the upper GI tract – Hook knife method. Minim Invasive Ther Allied Technol 2002; 11: 291–5.
Yahagi, N, Fujishiro, M, Imagawa, Aet al. Endoscopic submucosal dissection for the reliable en bloc resection of colorectal mucosal tumours. Dig Endosc 2004; 16: S89–S92.
Rembacken, BJ, Gotoda, T, Fujii, T and Axon, AT.Endoscopic mucosal resection. Endoscopy 2001; 33: 709–18.
Borie, F, Rigau, V, Fingerhut, A and Millat, B.French Association for Surgical Research. Prognostic factors for EGC in France: Cox regression analysis of 332 cases. World J Surg 2004; 28: 686–91.
Pelz, J, Merkel, S, Horbach, Tet al. Determination of nodal status and treatment in EGC. Eur J Surg Oncol 2004; 30: 935–41.
Gotoda, T, Yanagisawa, A, Sasako, Met al. Incidence of lymph node metastasis from EGC: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219–25.
Hirao, M, Masuda, K, Asanuma, Tet al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 1988; 34: 264–9.
Ohkuwa, M, Hosokawa, K, Boku, Net al. New endoscopic treatment for intramucosal gastric tumours using an insulated-tip diathermic knife. Endoscopy 2001; 33: 221–6.
Rosch, T, Sarbia, M, Schumacher, Bet al. Attempted endoscopic en bloc resection of mucosal and submucosal tumours using insulated-tip knives: a pilot series. Endoscopy 2004; 36: 788–801.
Fujishiro, M, Yahagi, N, Kashimura, Ket al. Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 2004; 36: 584–9.
Yamamoto, H, Yube, T, Isoda, Net al. A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999; 50: 251–6.
Fujishiro, M, Yahagi, N, Kashimura, Ket al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 2004; 36: 579–83.
Schlemper, RJ, Itabashi, M, Kato, Yet al. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet 1997; 349: 1725–9 (erratum in Lancet 1997; 350: 524).
Schlemper, RJ, Itabashi, M, Kato, Yet al. Differences in the diagnostic criteria used by Japanese and Western pathologists to diagnose colorectal carcinoma. Cancer 1998; 82: 60–9.
Schlemper, RJ, Dawsey, SM, Itabashi, Met al. Differences in diagnostic criteria for esophageal squamous cell carcinoma between Japanese and Western pathologists. Cancer 2000; 88: 996–1006.
Schlemper, RJ, Riddell, RH, Kato, Yet al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251–5.