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Features of Early Gastric Cancer and Gastric Adenoma by Enhanced-Magnification Endoscopy

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Toyoda, Hideki, M.D., Ph.D.; Tanaka, Kyosuke, M.D.; Kadowaki, Shigenori, M.D.; Kosaka, Ryo, M.D.; Hamada, Yasuhiko, M.D.; Shiraishi, Taizo, M.D., Ph.D.; Imoto, Ichiro, M.D., Ph.D.; Adachi, Yukihiko, M.D., Ph.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S52–S53
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: STOMACH
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Department of Endoscopic Medicine, Mie University School of Medicine, Tsu, Mie, Japan; Second Department of Internal Medicine, Mie University School of Medicine, Tsu, Mie, Japan and Second Department of Pathology, Mie University School of Medicine, Tsu, Mie, Japan.

Purpose: Changes to the mucosal surface of early gastric carcinomas and gastric adenomas, as viewed by enhanced-magnification endoscopy with acetic acid, have not been investigated thoroughly. Using this technology, this study investigated the appearance of the gastric surface pattern of neoplastic and surrounding non-neoplastic mucosa.

Methods: Forty-seven consecutive patients with early gastric carcinomas or gastric adenomas underwent enhanced-magnification endoscopy following 1.5% acetic acid instillation. All biopsy specimens were taken from the area at which the enhanced-magnified endoscopic image was obtained.

Results: Surface patterns of gastric tumor and the surrounding mucosa were classified into 5 types: type I, small round pits of uniform size and shape; type II, slit-like pits; type III, gyrus and villous patterns; type IV, irregular arrangement and size of types I, II and III; type V, destructive pattern of types I, II and III. The predominant pattern of the surrounding mucosa was type III, and most type III mucosa had characteristics of intestinal metaplasia. Although all elevated adenomas showed type II or type III surface patterns, both depressed adenomas showed type IV. Elevated carcinomas showed type III (42.9%) or type IV (57.1%) surface patterns; while depressed carcinomas showed type IV (70%) or type V (30%). Although differentiated tubular adenocarcinomas showed type III (10.3%), type IV (86.2%) or type V (3.5%) surface patterns, all of the signet-ring cell carcinomas and poorly-differentiated tubular adenocarcinoma showed type V.

Conclusions: Enhanced-magnification endoscopy may be useful for identifying gastric tumors and determining the extent of horizontal spread, especially in tumors of the depressed type.

© The American College of Gastroenterology 2005. All Rights Reserved.