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. 2010 Aug 23:10:97.
doi: 10.1186/1471-230X-10-97.

Acetic acid-indigo carmine chromoendoscopy for delineating early gastric cancers: its usefulness according to histological type

Bong Eun Lee  1 , Gwang Ha Kim, Do Youn Park, Dae Hwan Kim, Tae Yong Jeon, Su Bum Park, Hyun Seok You, Dong Yup Ryu, Dong Uk Kim, Geun Am Song
Affiliations

Acetic acid-indigo carmine chromoendoscopy for delineating early gastric cancers: its usefulness according to histological type

Bong Eun Lee et al. BMC Gastroenterol. .

Abstract

Background: Endoscopic treatments, such as endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy, are increasingly used to treat a subset of patients with early gastric cancer (EGC). To achieve successful outcomes, it is very important to accurately determine the lateral extent of the tumor. Therefore, we investigated the diagnostic performance of chromoendoscopy using indigo carmine dye added to acetic acid (AI chromoendoscopy) in delineating differentiated or undifferentiated adenocarcinomas in patients with EGC.

Methods: We prospectively included 151 lesions of 141 patients that had an endoscopic diagnosis of EGC. All the lesions were examined by conventional endoscopy and AI chromoendoscopy before ESD or laparoscopic gastrectomy. The border clarification between the lesion and the normal mucosa was classified as distinct or indistinct before and after AI chromoendoscopy.

Results: The borders of the lesions were distinct in 66.9% (101/151) with conventional endoscopy and in 84.1% (127/151) with AI chromoendoscopy (P < 0.001). Compared with conventional endoscopy, AI chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas (74/108 [68.5%] vs 97/108 [89.8%], respectively, P < 0.001). However, the border clarification rate for undifferentiated adenocarcinomas did not differ between conventional endoscopy and AI chromoendoscopy (27/43 [62.8%] vs 30/43 [70.0%], respectively, P = 0.494).

Conclusions: AI chromoendoscopy is useful in determining the lateral extent of EGCs. However, its usefulness is reduced in undifferentiated adenocarcinomas.

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Figures

Figure 1
Figure 1
Chromoendoscopy of a differentiated adenocarcinoma. (A) A combined flat and elevated lesion with an unclear border at the lower body of the stomach is shown. (B) Endoscopic view after acetic acid was sprinkled. (C) Endoscopic view after indigo carmine was additionally sprinkled. (D) Endoscopic view after the lesion was washed with clean water. After chromoendoscopy with indigo carmine dye added to acetic acid, the lesion's borders became distinct and the clarity of the image is high. The lesion was resected by endoscopic submucosal dissection and was shown to be a differentiated adenocarcinoma.
Figure 2
Figure 2
Chromoendoscopy of an undifferentiated adenocarcinoma. (A) A flat discolored lesion with an unclear border at the lower body of the stomach is shown. (B) Endoscopic view after acetic acid was sprinkled. (C) Endoscopic view after indigo carmine was additionally sprinkled. (D) Endoscopic view after the lesion was washed with clean water. After chromoendoscopy with indigo carmine dye added to acetic acid, the lesion's border was still indistinct and the image was mottled. The lesion was resected by laparoscopic gastrectomy and was shown to be an undifferentiated adenocarcinoma.
Figure 3
Figure 3
The rates of border clarification by conventional endoscopy and chromoendoscopy with indigo carmine dye added to acetic acid (AI chromoendoscopy) according to the histological type of the lesion.
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