Endoscopy 2002; 34(10): 772-777
DOI: 10.1055/s-2002-34267
Original Article

© Georg Thieme Verlag Stuttgart · New York

Routine Endoscopy Using a Magnifying Endoscope for Gastric Cancer Diagnosis

H.  Tajiri 1, 2 , T.  Doi 1 , H.  Endo 1 , T.  Nishina 1 , T.  Terao 1 , I.  Hyodo 1 , K.  Matsuda 2 , K.  Yagi 3
  • 1Department of Internal Medicine, National Shikoku Cancer Center, Ehime, Japan
  • 2Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
  • 3Department of Internal Medicine, Niigata Prefectural Hospital, Niigata, Japan
Further Information

Publication History

Submitted: 15 February 2001

Accepted after Revision: 21 May 2002

Publication Date:
23 September 2002 (online)

Background and Study Aims: It has been reported that the fine mucosal patterns of the gastric pits can be observed with magnification and this may assist in preliminary evaluation prior to histological diagnosis. The aim of this prospective study was to clarify the relationship between the fine mucosal patterns of gastric lesions and histological findings, and also to evaluate the usefulness of magnifying endoscopy during routine endoscopy.
Patients and Methods: A recently developed magnifying video endoscope, which enables magnification up to 80 times, was used for gastrointestinal endoscopy in 318 patients between January 2000 and January 2001, at the National Shikoku Cancer Center. In total, 232 lesions were detected. However, patients diagnosed by conventional endoscopy as having advanced gastric cancer, malignant lymphoma, or submucosal tumor were excluded from the study. The endoscopic findings for 211 lesions included in this study were compared with the histological findings.
Results: Coarse and irregular mucosal patterns were observed in elevated-type cancers by magnifying endoscopy, and in depressed-type cancers there was a finer pit pattern than in the surrounding mucosa, destruction or disappearance of the mucosal microstructure, and abnormal capillary vessels. The magnifying endoscopy results were closely related to the mucosal microstructure observed by dissecting microscopy and to the histological features. The rate of presumptive diagnosis of small gastric cancers was significantly higher when a magnifying endoscope was used compared with conventional endoscopy. In this study, the sensitivity and specificity of magnifying endoscopy as a diagnostic method were 96.0 % and 95.5 %, respectively.
Conclusions: The fine mucosal patterns and the features of capillary vessels, which were identified with the magnifying endoscope, correlated well with the pathological diagnosis. Magnifying endoscopy will be very useful in predicting the histological diagnosis during routine endoscopic procedures.

References

  • 1 Tajiri H, Ohtsu A, Boku N. et al . Routine endoscopy using electronic endoscopes for gastric cancer diagnoses: retrospective study of inconsistencies between endoscopic and biopsy diagnoses.  Cancer Detect Prev. 2001;  25 166-173
  • 2 Honda T. Study on the mucosal microstructure of gastric elevated lesions with the magnifying electronic endoscopic, dissecting microscopic and histological findings (in Japanese with English abstract).  Gastroenterol Endosc. 1993;  35 967-977
  • 3 Cales P, Oberti F, Delmotte J S. et al . Gastric mucosal surface in cirrhosis evaluated by magnifying endoscopy and scanning electronic microscopy.  Endoscopy. 2000;  32 614-623
  • 4 Urita Y, Nishino M, Koyama H. et al . Magnifying observation of ectopic gastric mucosa of the cervical esophagus.  Dig Endosc. 1995;  7 208-214
  • 5 Japanese Research Society for Gastric Cancer .The general rules for the Gastric Cancer Study. Tokyo; Kanehara 1993 12th ed.
  • 6 Yoshida S, Yoshimori M, Tajiri H. et al . Nonulcerative lesion detected as an early expression of gastric malignancy.  Jpn J Clin Oncol. 1981;  11 495-506
  • 7 Hoshihara Y, Hashimoto M, Okuda C. et al . Endoscopic findings of gastric ulcer scars: morphological changes of regenerated epithelium during the healing process (in Japanese with English abstract).  Endosc Digest. 1993;  5 45-51
  • 8 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumourous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
  • 9 Koba I, Yoshida S, Fujii T. et al . Diagnostic findings in endoscopic screening of superficial colorectal neoplasia: results from a prospective study.  Jpn J Clin Oncol. 1998;  28 542-545
  • 10 Akisato K. A microangiographic study on the vascular patterns of gastric cancer (in Japanese with English abstract).  Keio J Med. 1973;  50 21-36
  • 11 Muguruma N, Ito S, Hayashi S. et al . Antibodies labeled with fluorescence-agent excitable by infrared rays.  J Gastroenterol. 1998;  33 467-471

H. Tajiri, M.D.

Department of Endoscopy · The Jikei University School of Medicine

3-25-8, Nishishinbashi · Minato-ku · Tokyo 105-8461 · Japan

Fax: + 81-3-34594524

Email: tajiri@jikei.ac.jp

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