Acetic acid-indigo carmine chromoendoscopy for delineating early gastric cancers: its usefulness according to histological type

Bong Eun Lee, Gwang Ha Kim, Do Youn Park, Dae Hwan Kim, Tae Yong Jeon, Su Bum Park, Hyun Seok You, Dong Yup Ryu, Dong Uk Kim, Geun Am Song, Bong Eun Lee, Gwang Ha Kim, Do Youn Park, Dae Hwan Kim, Tae Yong Jeon, Su Bum Park, Hyun Seok You, Dong Yup Ryu, Dong Uk Kim, Geun Am Song

Abstract

Background: Endoscopic treatments, such as endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy, are increasingly used to treat a subset of patients with early gastric cancer (EGC). To achieve successful outcomes, it is very important to accurately determine the lateral extent of the tumor. Therefore, we investigated the diagnostic performance of chromoendoscopy using indigo carmine dye added to acetic acid (AI chromoendoscopy) in delineating differentiated or undifferentiated adenocarcinomas in patients with EGC.

Methods: We prospectively included 151 lesions of 141 patients that had an endoscopic diagnosis of EGC. All the lesions were examined by conventional endoscopy and AI chromoendoscopy before ESD or laparoscopic gastrectomy. The border clarification between the lesion and the normal mucosa was classified as distinct or indistinct before and after AI chromoendoscopy.

Results: The borders of the lesions were distinct in 66.9% (101/151) with conventional endoscopy and in 84.1% (127/151) with AI chromoendoscopy (P < 0.001). Compared with conventional endoscopy, AI chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas (74/108 [68.5%] vs 97/108 [89.8%], respectively, P < 0.001). However, the border clarification rate for undifferentiated adenocarcinomas did not differ between conventional endoscopy and AI chromoendoscopy (27/43 [62.8%] vs 30/43 [70.0%], respectively, P = 0.494).

Conclusions: AI chromoendoscopy is useful in determining the lateral extent of EGCs. However, its usefulness is reduced in undifferentiated adenocarcinomas.

Figures

Figure 1
Figure 1
Chromoendoscopy of a differentiated adenocarcinoma. (A) A combined flat and elevated lesion with an unclear border at the lower body of the stomach is shown. (B) Endoscopic view after acetic acid was sprinkled. (C) Endoscopic view after indigo carmine was additionally sprinkled. (D) Endoscopic view after the lesion was washed with clean water. After chromoendoscopy with indigo carmine dye added to acetic acid, the lesion's borders became distinct and the clarity of the image is high. The lesion was resected by endoscopic submucosal dissection and was shown to be a differentiated adenocarcinoma.
Figure 2
Figure 2
Chromoendoscopy of an undifferentiated adenocarcinoma. (A) A flat discolored lesion with an unclear border at the lower body of the stomach is shown. (B) Endoscopic view after acetic acid was sprinkled. (C) Endoscopic view after indigo carmine was additionally sprinkled. (D) Endoscopic view after the lesion was washed with clean water. After chromoendoscopy with indigo carmine dye added to acetic acid, the lesion's border was still indistinct and the image was mottled. The lesion was resected by laparoscopic gastrectomy and was shown to be an undifferentiated adenocarcinoma.
Figure 3
Figure 3
The rates of border clarification by conventional endoscopy and chromoendoscopy with indigo carmine dye added to acetic acid (AI chromoendoscopy) according to the histological type of the lesion.

References

    1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108. doi: 10.3322/canjclin.55.2.74.
    1. Shin HR, Won YJ, Jung KW, Kong HJ, Yim SH, Lee JK, Noh HI, LEE JK, Pisani P, Park JG. Nationwide cancer incidence in Korea, 1999-2001: first result using the national cancer incidence database. Cancer Res Treat. 2005;37:325–331. doi: 10.4143/crt.2005.37.6.325.
    1. Rubin E, Palazzo J. In: Rubin's pathology. Rubin E, Gorstein F, Rubin F, Schwarting R, Strayer D, editor. Philadelphia: Lippincott Williams & Wilkins; 2005. The gastrointestinal tract; pp. 660–739.
    1. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer. 2002;5:177–182. doi: 10.1007/s101200200031.
    1. Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, Chun HJ, Park JJ, Lee WS, Kim HS, Chung MG, Moon JS, Choi SR, Song GA, Jeong HY, Jee SR, Seol SY, Yoon YB. EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc. 2007;66:693–700. doi: 10.1016/j.gie.2007.04.013.
    1. Min BH, Lee JH, Kim JJ, Shim SG, Chang DK, Kim YH, Rhee PL, Kim KM, Park CK, Rhee JC. Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: Comparison with endoscopic mucosal resection after circumferential precutting (EMR-P) Dig Liver Dis. 2008;41:201–209. doi: 10.1016/j.dld.2008.05.006.
    1. Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM. Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol. 2008;15:1625–1631. doi: 10.1245/s10434-008-9845-x.
    1. Lee JH, Ryu KW, Doh YW, Bae JS, Kim YW, Bae JM. Liver lift: A simple suture technique for liver retraction during laparoscopic gastric surgery. J Surg Oncol. 2007;95:83–85. doi: 10.1002/jso.20611.
    1. Demirci S, Gohchi A. A comparative study for fiberoptic and video endoscopic determination of the extent in minimal changes of gastric mucosa using indigo dye spraying. Surg Endosc. 1990;4:80–82. doi: 10.1007/BF00591263.
    1. Okabayashi T, Gotoda T, Kondo H, Ono H, Oda I, Fujishiro M, Yachida S. Usefulness of indigo carmine chromoendoscopy and endoscopic clipping for accurate preoperative assessment of proximal gastric cancer. Endoscopy. 2000;32:S62. doi: 10.1055/s-2000-139.
    1. Tanaka K, Toyoda H, Kadowaki S, Kosaka R, Shiraishi T, Imoto I, Shiku H, Adachi Y. Features of early gastric cancer and gastric adenoma by enhanced-magnification endoscopy. J Gastroenterol. 2006;41:332–338. doi: 10.1007/s00535-005-1760-3.
    1. Otsuka Y, Niwa Y, Ohmiya N, Ando N, Ohashi A, Hirooka Y, Goto H. Usefulness of magnifying endoscopy in the diagnosis of early gastric cancer. Endoscopy. 2004;36:165–169. doi: 10.1055/s-2004-814184.
    1. Sakai Y, Eto R, Kasanuki J, Kondo F, Kato K, Arai M, Suzuki T, Kobayashi M, Matsumura T, Bekku D, Ito K, Nakamoto S, Tanaka T, Yokosuka O. Chromoendoscopy with indigo carmine dye added to acetic acid in the diagnosis of gastric neoplasia: a prospective comparative study. Gastrointest Endosc. 2008;68:635–641. doi: 10.1016/j.gie.2008.03.1065.
    1. Iizuka T, Kikuchi D, Hoteya S, Yahagi N. The acetic acid + indigocarmine method in the delineation of gastric cancer. J Gastroenterol Hepatol. 2008;23:1358–1361. doi: 10.1111/j.1440-1746.2008.05528.x.
    1. Japanese Gastric Cancer A. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer. 1998;1:10–24.
    1. Gotoda T, Kondo H, Ono H, Saito D, Shimoda T. Result of an endoscopic mucosal resection demonstrated at the International Gastric Cancer Congress in New York. Gastric Cancer. 2002;5:183–184. doi: 10.1007/s101200200032.
    1. Ryu KW, Lee JH, Choi IJ, Bae JM. Preoperative endoscopic clipping: localizing technique of early gastric cancer. J Surg Oncol. 2003;82:75–77. doi: 10.1002/jso.10191.
    1. Yamashita H, Kitayama J, Ishigami H, Yamada J, Miyato H, Kaisaki S, Nagawa H. Endoscopic instillation of indigo carmine dye with acetic acid enables the visualization of distinct margin of superficial gastric lesion; Usefulness in endoscopic treatment and diagnosis of gastric cancer. Dig Liver Dis. 2007;39:389–391. doi: 10.1016/j.dld.2006.12.012.
    1. Guelrud M, Herrera I. Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy. Gastrointest Endosc. 1998;47:512–515. doi: 10.1016/S0016-5107(98)70253-6.
    1. Yagi K, Aruga Y, Nakamura A, Sekine A, Umezu H. The study of dynamic chemical magnifying endoscopy in gastric neoplasia. Gastrointest Endosc. 2005;62:963–969. doi: 10.1016/j.gie.2005.08.050.

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