indigo-carmine and Adenocarcinoma--Papillary

Detection of early gastric tube cancers (GTCs) has increased with more detailed surveillance endoscopy using indigo carmine dye following esophagectomy. This retrospective study clarified the clinicopathological features and application of endoscopic submucosal dissection (ESD) for GTCs. Data collected for eight GTCs treated by ESD included clinical and pathological features and outcomes following ESD. Overall, eight GTCs were identified in seven (6.3 %) of 112 patients who underwent esophagectomy and gastric tube reconstruction. Almost all lesions were macroscopically type 0-IIa with mucosal to submucosal invasion, and seven GTCs were successfully resected en bloc by ESD. Submucosal invasion to > 500 microm was observed in one case with associated delayed perforation that was treated conservatively. No local recurrences of GTCs were observed. Detailed surveillance endoscopy using indigo carmine dye appears useful for diagnosing early-stage GTC. Furthermore ESD represents a feasible alternative to conventional endoscopic mucosal resection as a minimally invasive therapy for early-stage GTC.

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Aged; Aged, 80 and over; Coloring Agents; Dissection; Endoscopy, Gastrointestinal; Esophageal Neoplasms; Esophagectomy; Esophagostomy; Female; Gastrectomy; Gastric Mucosa; Gastrostomy; Humans; Indigo Carmine; Middle Aged; Neoplasms, Squamous Cell; Plastic Surgery Procedures; Stomach Neoplasms

During the last 10 years, we have experienced 41 cases of minute cancer, which is equivalent to 13.9% of all resected early stomach cancers. Out of 44 lesions in 41 cases, 17 lesions were diagnosed preoperatively, while 27 were unexpectedly detected by serial sections of the resected stomach. Most lesions were located along the lesser curvature of the body and antrum. There was no nodal involvement or vessel permeation. Histologically differentiated adenocarcinomas were encountered in 86.4%, associated with intensive intestinal mucosa in many cases. We have stressed that dye endoscopy using indigo carmine and methylene blue is very useful for the diagnosis of minute cancer.

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Adult; Aged; Female; Gastric Mucosa; Humans; Hyperplasia; Indigo Carmine; Male; Metaplasia; Methylene Blue; Middle Aged; Sex Factors; Staining and Labeling; Stomach Neoplasms