Improved optical identification of laterally spreading type "0-IIb" gastric lesion with narrow band imaging magnification endoscopy

Authors Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shigeharu Hamatani, Shin-ei Kudo.


Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric cancer. Accurate identification of tumor borders is crucial for curative ESD. Narrow band imaging magnification endoscopy (NBI-ME) has been effectively used for assessment of superficial gastric lesions; however, international experience in type "0-IIb" gastric lesions is limited. Successful endoscopic tissue characterization of laterally spreading type "0-IIb" early gastric cancer in a 74-year-old male with known type "0-IIa" lesion, using zoom NBI-ME, is reported. While the type "0-IIa" gastric lesion was clearly recognized by white light endoscopy and indigo carmine chromoendoscopy, the laterally spreading type "0-IIb" gastric cancer was only identified on the basis of NBI-ME malignant microvascular and mucosal microsurface pattern. Based on NBI-ME findings, accurate border marking approximately 1 mm apart from the demarcation line and complete en bloc ESD resection of both tumors was successfully succeeded. Recovery was uneventful. Histopathology showed moderately differentiated gastric adenocarcinoma in type "0-IIa" lesion and a small area of low-grade well-differentiated gastric adenocarcinoma in type "0-IIb" lesion. Conclusively, improved real-time optical identification of laterally spreading type "0-IIb" gastric lesion was achieved with NBI-ME.

Keywords Narrow band imaging, magnifying endoscopy, early gastric cancer, endoscopic submucosal dissection

Ann Gastroenterol 2014; 27 (3): 267-269

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