Preoperative (EMR) Diagnosis of Early Gastric Cancer from the View Point of Endoscopy Satoshi Tanabe 1 1Department of Internal Medicine, School of Medicine, Kitasato University Keyword: 早期胃癌 , 内視鏡的粘膜切除術 , 術前診断 , 同時性多発胃癌 , 異時性多発胃癌 pp.1615-1624
Published Date 2001/12/25
DOI https://doi.org/10.11477/mf.1403103384
  • Abstract
  • Look Inside
  • Cited by

 We performed curative endoscopic mucosal resection (EMR) in 149 patients (155 lesions) with the purpose of studying the current status and problems of preoperative diagnosis for EMR. Similar numbers of protruded type lesions (78) and flat/depressed type lesions (77) were studied. Twenty-six lesions (16.8%) were detected on X-ray film, and 129 (83.2%) were detected by endoscopic examination. The extent of tumor invasion was preoperatively misdiagnosed in 2 patients with flat/depressed type lesions but in none of the patients with protruded type lesions. The depth of invasion was correctly estimated for 93.6% of protruded type lesions as compared with 89.6% of flat/depressed type lesions. When classified according to the depth of invasion,97.2% of mucosal carcinomas and 37.5% of submucosal carcinomas (protruded type,50%; flat/depressed type 30%) were accurately diagnosed before treatment. Synchronous gastric carcinomas were diagnosed in 9 patients (6.0%). Both lesions were protruded type in 7 (77.8%) of these patients. Metachronous gastric carcinomas were diagnosed in 8 patients (5.4%), The second tumor was detected within 2 years in 5 (62.5%) of these patients. Four patients (2.7%) had residual tumor or recurrence. The extent of tumor invasion was correctly diagnosed before EMR in 2 of these patients and incorrectly diagnosed in the other 2 (indistinct tumor border in one and the impossibility of adequate examination in the other, becouse of its being located in the posterior wall of the angulus. Our results indicate that radiographic examination alone has limitations in the detection and diagnosis of lesions able to be treated by EMR, particularly in patients with flat/depressed type lesions. Endoscopic examination should therefore be performed concurrently. The preoperative preparations for EMR should include detailed examinations after spraying lesions with dye. Concurrent step biopsy is also useful for the assessment of poorly demarcated lesions. Submucosal microinvasion (sm1) is considered to represent the limit of endoscopic diagnosis.

Copyright © 2001, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院