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GIT Kurdistan Board GEH Journal club IEE to detect EGC.
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Eraly Gastric Cancer Detection
Dr.Mohamed Alshehani.
Abstract:• Image-enhanced endoscopy(IEE) techniques of enhancing mucosa surface
contrast with the ultimate aim of improving lesion detection & diagnosis.• The aim is to detect early gastric cancer(EGC) to perform curative
endoscopic resection. • IEE include:• Traditional dye-based chromoendoscopy Newer equipment-based
techniques:• Narrow-band imaging +/- magnifying endoscopyto facilitate lesion
characterization&diagnosis based on characteristic abnormal microvascular & microsurface features.
• Flexible spectral imaging color enhancement• I-scan.• Other IEE modalities: autofluorescence imaging& endoscopic microscopy.
Introduction:• GC is the 4th most common cancer in men, the 5th most common
cancer in women& the 2nd leading cause of death due to cancer.
• 10% of annual cancer deaths worldwide are attributed to gastric cancer & has a high fatality/ case ratio of 70%.
• The highest incidence rates occur in East Asia (China, Mongolia, Korea, Japan).
• Histologically divided into two types in the Lauren classification:
• Intestinal (with intercellular junctions)
• Diffuse (without intercellular junctions).
• >90% are intestinal-type adenocarcinoma, preceded by a “precancerous cascade,” progressing in a sequential manner from chronic gastritis, atrophic gastritis, intestinal metaplasia, adenoma to early gastric cancer (EGC).
Introduction:• The overall prognosis is dismal; the average 5-year survival is <20%.• EGC are often clinically silent but if detected& endoscopically
resected prior to invasion into the muscularis propria, the 5-year survival rate can reach 90%.
• EGC, a term defined by Japanese researchers in 1962, means curable phase of the disease when cancer cells are confined within the mucosal or submucosal layer (T1 cancer) regardless of the presence of lymph node metastasis.
• Endoscopic resection using (EMR) or (ESD) is potentially curative for the patient if there is no nodal metastasis& can avoid the morbidity associated with gastrectomy.
• Candidates for EMR in EGC: differentiated adenocarcinoma, <2-3 cm, no ulceration, no lymphovascular involvement.
Introduction:• En bloc resection is crucial for accurate histopathological
assessment and, for lesions larger than 2 cm or in the presence of fibrosis or ulceration, ESD rather than EMR would be the technique of choice.
Introduction:• The sensitivity of conventional white light imaging (C-WLI) in
detecting EGC range only from 77- 84%.
• (IEE) involves the use of dyes, optical methods (by manipulation of the light source)& electronic methods (by manipulation of captured light), to increase the contrast of surface structure&improve visualization&diagnostic accuracy.
• There are three different commercially available systems for equipment-based IEE:
• (1) narrow-band imaging (NBI; Olympus)
• (2) Flexible spectral imaging color enhancement (FICE; Fujifilm);
• (3) iscan (Pentax).
• IEE can be combined with magnifying endoscopy to further characterize focal lesions.
Conclusion:
• HD C-WLI remains the main imaging modality for detection of focal gastric lesions.
• IEE is an important tool for the diagnosis&characterization of EGC.
• There is substantial evidence that the combination of C-WLI &NBI-ME is superior to C-WLI alone or chromoendoscopy in terms of diagnostic accuracy& delineating tumor margins.
• In the era when endoscopic resection guidelines are being expanded, IEE should become a standardof practice as the early detection of gastric cancer allows curative treatment.