By Tsuneo Oyama
This publication makes a speciality of the preoperative analysis of early-stage gastric melanoma, offering numerous situations and their diagnoses utilizing Endoscopic Submucosal Dissection (ESD), a brand new approach for dissecting early-stage gastric melanoma. the 1st bankruptcy provides varied situations with specific reasons and observations, therefore offering simple wisdom of invasion intensity prognosis, diagnostic assurance, and qualitative analysis. the second one a part of this e-book extra expands on those subject matters with extra examples and present practices prior to concluding with an in-depth examine the applying in difficult-to-treat instances, entire with an enormous variety of figures and certain diagnoses.
Edited and authored by means of pioneering researchers within the box, Preoperative analysis of Gastric Cancer is designed as a textbook for clinicians and execs within the fields of endoscopy and gastroenterology.
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Additional info for Endoscopic Diagnosis of Superficial Gastric Cancer for ESD
A) WL endoscopy shows reddish mucosa with unclear demarcation on the greater curvature of a gastric middle to lower body. (b) Chromoendoscopy using indigo carmine shows a lesion with rough mucosa and unclear demarcation compared with the background mucosa. It is difficult to determine whether this is a neoplastic tumor or not by WL endoscopy and chromoendoscopy using indigo carmine. (c, d, e) NBI magnified endoscopy of the oral side of the lesion showed a regular pit-like pattern on the lower right side of the picture (c).
A) NBI magnified endoscopic image. (b) Image obtained after acetic acid spraying Surface pattern and Histological type villi pit Unclear Well-differentiated Moderately-differentiated Poorly-differentiated Fig. 14 Chart 1 surface pattern and histological type 5 Diagnosis of Gastric Adenocarcinoma with Magnified Endoscopy 47 Fig. 1 Villous Pattern Irregular villous patterns can confirm diagnosis of WDA regardless of vascular patterns. But, when villous patterns show fusion of villi, moderate to PDA must be distinguished.
B) Chromoendoscopy using indigo carmine shows a lesion with rough are influenced differently by acid in tumor parts compared with nontumor parts. While indigo carmine sprayed to tumor parts get washed out easily, indigo carmine sprayed to nontumor parts tend to remain unwashed. We can diagnose the borders of the lesions clearly by this mechanism (Fig. 6). mucosa as compared with the background mucosa. However, it still shows unclear demarcation without additional information. 4 NBI Magnified Endoscopy 33 Gastric lumens are wide, and nonmagnified NBI images appear too dark for meaningful evaluations.