Takahashi Haruo, Miura Yoshimasa, Osawa Hiroyuki, Takezawa Takahito, Ino Yuji, Okada Masahiro, Lefor Alan Kawarai, Yamamoto Hironori
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Clin Endosc. 2019 May;52(3):273-277. doi: 10.5946/ce.2018.100. Epub 2018 Aug 14.
Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished from inflamed mucosa. We treated a patient with a small early gastric cancer that was difficult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, blue laser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from the surrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even with small-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosal dissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinoma localized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. This small early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.
传统内镜检查常常会漏诊仅有轻微红色变色的早期胃癌，因为它们无法与炎症黏膜区分开来。我们治疗了一名患有难以通过传统内镜检查诊断的小早期胃癌患者。使用小口径内镜的传统内镜检查仅显示胃黏膜有细微的红色变色。然而，蓝色激光成像显示在红色病变周围有一个直径为10毫米的明显变色区域，与周围炎症黏膜不同。即使使用小口径内镜也观察到肿瘤表面有不规则血管（怀疑为早期胃癌）。活检显示为中分化管状腺癌，并进行了内镜下黏膜下剥离术。标本的组织病理学检查证实为中分化腺癌，局限于黏膜层，与周围黏膜相比有轻微凹陷，与内镜检查结果一致。通过使用小口径内镜的蓝色激光成像，这种小早期胃癌变得清晰可见。
