Endoscopic Submucosal Dissection for Early Gastric Cancer Using Magnifying Endoscopy With a Combination of Narrow Band Imaging and Acetic Acid Instillation

Abstract

Demarcation of early gastric cancers is sometimes unclear. Enhanced-magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72-year-old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well-differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.

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

“…Furthermore, NBI-ME, which yields very clear images of microvessels on mucosal surfaces, is capable of predicting the histological characteristics of gastric cancers and may be useful for identifying the demarcation line [18]. We have reported that NBI-EME improved the visualization of the fine surface pattern [20,21] and demarcation of gastric cancer [22].…”

“…The diagnostic value of combining the NBI system with ME (NBI-ME) in various organs has been described previously [18,19]. Furthermore, we reported that ME combined with NBI and acetic acid instillation (NBI-EME) might improve visualization of the microstructure of gastric mucosa [20][21][22].…”

Ease of early gastric cancer demarcation recognition: A comparison of four magnifying endoscopy methods

“…In NBI‐ME images, EGC demarcations were recognized by differences in capillary structures 14 . We recently reported on EGC cases in which NBI‐EME improved the contrast in images of fine surface patterns and demarcations 15,16 . A comparative investigation of the overall success of different ME methods has not been published.…”

“…Furthermore, NBI‐ME provides a detailed assessment of the extent of EGC 14 . Previously, we reported that ME with a combination of NBI and acetic acid instillation (NBI‐EME) further improves contrast in images of fine surface patterns and demarcations 15–17 …”

“…14 Previously, we reported that ME with a combination of NBI and acetic acid instillation (NBI-EME) further improves contrast in images of fine surface patterns and demarcations. [15][16][17] Though various methods involving ME are used for EGC diagnosis, no comparative investigations have been published reporting the overall success of different ME methods. The aim of the present study was to rank four methods-CME, NBI-ME, EME and NBI-EME-for ease of recognition of EGC demarcation.…”