Eleftheriadis Nikolas, Inoue Ηaruhiro, Ikeda Haruo, Onimaru Manabu, Yoshida Akira, Maselli Roberta, Santi Grace, Hamatani Shigeharu, Kudo Shin-Ei
Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
Department of Pathology (Shigeharu Hamatani), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
Ann Gastroenterol. 2015 Jan-Mar;28(1):72-80.
Endoscopic submucosal dissection (ESD) is currently considered the minimal invasive endoscopic treatment for early gastric cancer. Most superficial gastric neoplastic lesions are depressed type "0-IIc" (70-80%), while totally flat, classified as type "0-IIb" early gastric cancer, is rarely reported (0.4%). The aim of the present study was to assess the efficacy of narrow band imaging (NBI) magnification endoscopy in identifying type "0-IIb" early gastric cancer and ESD treatment with curative intention.
Twelve of 615 (2%) patients (10 males, median 72 years), treated by ESD at our center, were diagnosed as type "0-IIb" gastric cancer. Ten had exclusively type "0-IIb", while two had combined types "0-IIb+IIc" and "0-IIa+IIb" gastric cancer. Initial diagnosis was made during screening gastroscopy, while NBI magnification endoscopy combined with indigo-carmine chromoendoscopy were also used.
White light endoscopy showed only superficial redness. One patient with signet-ring carcinoma showed whitish appearance. Indigo-carmine chromoendoscopy showed better visualization, while NBI magnification endoscopy revealed abnormal mucosal microsurface and microvascular findings which enabled border marking. ESD with curative intention was completed without complications. Histological examination showed complete (R0) resection, in 10 patients (83%). One patient with positive margins received additional surgery (8%). Mean procedure time was 149 (range 60-190) min. One to six years post-ESD all patients remain alive.
ESD is considered a safe and effective curative treatment for type "0-IIb" gastric cancer, resulting in long-term disease-free survival. NBI magnification endoscopy is effective for accurate optical identification and border marking of type "0-IIb" early gastric cancer.
内镜黏膜下剥离术（ESD）目前被认为是早期胃癌的微创内镜治疗方法。大多数浅表性胃肿瘤性病变为凹陷型“0-IIc”（70-80%），而完全平坦的、分类为“0-IIb”型的早期胃癌很少见（0.4%）。本研究的目的是评估窄带成像（NBI）放大内镜在识别“0-IIb”型早期胃癌及进行根治性ESD治疗方面的疗效。
在我们中心接受ESD治疗的615例患者中有12例（2%）（10例男性，中位年龄72岁）被诊断为“0-IIb”型胃癌。10例为单纯“0-IIb”型，2例为“0-IIb+IIc”和“0-IIa+IIb”混合型胃癌。最初诊断是在筛查胃镜检查时做出的，同时也使用了NBI放大内镜联合靛胭脂染色内镜检查。
白光内镜仅显示浅表发红。1例印戒细胞癌患者显示白色外观。靛胭脂染色内镜检查显示视野更佳，而NBI放大内镜揭示了异常的黏膜微表面和微血管表现，从而能够进行边界标记。根治性ESD顺利完成，无并发症发生。组织学检查显示10例患者（83%）实现了完全（R0）切除。1例切缘阳性患者接受了额外手术（8%）。平均手术时间为149（60-190）分钟。ESD术后1至6年，所有患者均存活。
ESD被认为是治疗“0-IIb”型胃癌的一种安全有效的根治性方法，可实现长期无病生存。NBI放大内镜对于准确光学识别和标记“0-IIb”型早期胃癌的边界有效。
