Ulcerous Change Decreases the Accuracy of Endoscopic Ultrasonography Diagnosis for the Invasive Depth of Early Gastric Cancer

Akashi, Ken; Yanai, Hideo; Nishikawa, Jun; Satake, Masaaki; Fukagawa, Yuki; Okamoto, Takeshi; Sakaida, Isao

doi:10.1007/s12029-007-9004-9

Cited by 46 publications

(60 citation statements)

References 24 publications

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“…It is important to investigate the invasive depth of the tumor before ESD. However, the accuracy of T staging in EGC with ulcer is very low [14]. Third, the presence of ulceration interferes with complete resection and promotes a long procedure time and high risk of adverse events such as bleeding and perforation [3,[6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

et al. 2015

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Background In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. Methods A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. Results The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P \ 0.001). The procedure time was 38.1 ± 35.7 and 50.8 ± 50.2 min (P = 0.047). However, no significant differences were detected in the en bloc resection rate, complete resection rate, and adverse events including bleeding and perforation. Multivariate analysis showed that administration of PPI (OR = 10.83, P \ 0.001) and mucosal invasion (OR = 24.43, P \ 0.001) were independent factors that predicted complete healing of ulceration. The calculated accuracy for whether complete healing of the ulcer after PPI administration can differentiate mucosal from submucosal invasion was 75.3 %. Conclusions Administration of PPI before ESD in differentiated EGC meeting the expanded criteria is effective to heal the ulcer lesion and reduce the mean procedure time. Complete healing of the ulcer after PPI administration suggests mucosal cancer.

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Section: Discussionmentioning

confidence: 99%

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

et al. 2015

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“…This contributes to disease estimation, selection of surgical procedure and prognosis assessment (Willis et al 2000;Kwee and Kwee 2007). With constant improvements in EUS, its superiority in T and N staging of gastric cancer has been demonstrated (Greenberg et al 1994;Hizawa et al 2002;Akashi et al 2006). However, due to the limitation of the probe frequency of endoluminal sonography and the penetration depth of the ultrasonic beam, its inferiority in M staging of gastric cancer (i.e., its incapacity to accurately predict the distant metastasis of gastric cancer) is also shown (Ziegler et al 1993;Bhandari et al 2004;Chen et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Zheng

Zhu

et al. 2012

Tohoku J. Exp. Med.

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Accurate staging of gastric cancer is helpful to determine the most appropriate therapy, but no staging modality has been accepted as the standard. Objective is to evaluate the usefulness of endoscopic ultrasonograph (EUS) combined with position emission tomography and computed tomograph (PET-CT) in gastric cancer staging. A total of 124 patients confirmed with gastric cancer were subjected to staging with EUS and PET-CT scanning. The detection rate of primary tumor was 99.2% by combination use of two modalities and 97.6% by EUS alone ( p = 0.6219), but the detection rate was 90.3% (112 of 124) by PET-CT alone (compared with the combination, p = 0.0027; compared with EUS alone, p = 0.0299). The locoregional lymph node invasion was identified in 84/124 (67.7%) by combined PET-CT and EUS, which was obviously higher than that with EUS (52.4%) or PET-CT (43.5%) alone ( p = 0.0194 and p = 0.0002, respectively). There was no statistical difference in identification of celiac axis lymph node metastasis among three methods, but the combined examination or PET-CT alone was more effective than EUS alone in the detection of distant metastases (all p < 0.01). Furthermore, the combined EUS and PET-CT was more optimal than using EUS or PET-CT alone in the accurate T and N staging and the effect on change of treatment. The present study indicates that the combination of EUS and PET-CT is an ideal modality in the preoperative staging of gastric cancer and it provides beneficial guidance for the treatment of gastric cancer.

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“…In addition, Choi et al demonstrated that EUS was not superior to white light endoscopy in terms of determining the depth of cancer invasion in patients with suspected EGC (67.4 vs 73.7 %, respectively; n = 955) [27]. At the very least, endoscopists need to recognize that accurate determination of the depth of invasion with EUS could be difficult if the lesion is larger than 5 cm and associated with an ulcer scar [28][29][30].…”

Section: Depth Diagnosis Of Egcmentioning

confidence: 99%

Past and current trends in endoscopic diagnosis for early stage gastric cancer in Japan

Sumiyama

2016

Gastric Cancer

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Methodology for the diagnosis and staging of early gastric cancer (EGC) has improved in Japan since the development of the gastro-camera and determination of a definition of EGC. Imaging technology has been steadily evolving in the endoscopy field. Improvements in the resolution of standard endoscopy images used in screening and surveillance provide greater opportunities to find gastric cancer earlier. Image enhancement endoscopy (IEE), such as narrow band imaging (NBI), highlights mucosal structures and vascularity. In particular, when NBI is used with magnifying endoscopy, it reveals fine details of subtle superficial abnormalities of EGC that are difficult to recognize using standard white light endoscopy. IEE-assisted magnifying endoscopy has improved the accuracy of the differentiation of superficial gastric cancer as well as delineation of the diseased mucosa. The advanced imaging technology enables precise assessment of the risk of lymph node metastasis of EGC and is widely used to determine indications for endoscopic treatment. It is not an overstatement to say that this has become the basis for the current development and dissemination of endoscopic treatments. Moreover, the resolution of endoscopic imaging has been upgraded to the microscopy level by the development of endomicroscopy, including endocytoscopy and confocal laser endomicroscopy. Endomicroscopy allows real-time histological analysis of living tissue during routine endoscopy and may reduce the number of biopsies needed to reach the correct diagnosis, minimizing the risk of sampling errors.

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Ulcerous Change Decreases the Accuracy of Endoscopic Ultrasonography Diagnosis for the Invasive Depth of Early Gastric Cancer

Abstract: The accuracy of endoscopic ultrasonography tumor staging was not sufficient for the lesions with ulcerous changes in our study. Therefore, we should be careful to perform endoscopic submucosal dissection for lesions with ulcerous changes.

Cited by 46 publications

References 24 publications

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Past and current trends in endoscopic diagnosis for early stage gastric cancer in Japan

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