Early Gastric Cancer€¦ · Early Gastric Cancer 15.6.2007 Endosonography & OCT. University Mainz 15.6.2007 Early Gastric Cancer Rösch, Gastrointest Clin North Am 1995 Accuracy

University Mainz

Early Gastric Cancer15.6.2007

Early Gastric Cancer

Ralf KiesslichJohannes Gutenberg University Mainz, Germany

University Mainz

DIAGNOSIS

University Mainz

15.6.2007Early Gastric Cancer

Unmask lesions

- Chromoendoscopy

Red flag technology

- Autofluorescence

Surface and detail analysis

- Magnifying endoscopy

- High resolution endoscopy

In vivo histology: Cellular architecture

- Endocytoscopy (surface)

- Endomicroscopy (whole mucosal layer)

Tissue architecture

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CHROMOENDOSCOPY

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Type O-I: Protruted type

Type O-IIa: Superficial elevated type

Type O-IIb: Flat type

Type O-IIc: Superficial depressed type

Type O-III: Excavated type

Japanese Classification

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Type I

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Type IIa

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Type IIa+IIc

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Magnifying Endoscopy

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High risk population

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Hereditary diffuse gastric

Hereditary diffuse gastric cancer is defined by germline

mutations in the E-cadherin gene, CDH-1.

Penetrance is 70%.

Congo red/methylene blue detected carcinoma foci 4-10

mm in size but not foci <4 mm.

Chromogastroscopy represents an improved

surveillance technique that can be safely considered

alongside prophylactic gastrectomy.

Shaw et al. Gut 2005

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Shaw et al. Gut 2005

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Filter Technology

NBI – FICE - SURFACE

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ConventionalFilter

NBIFilter

Narrow Band Imaging

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Kara et al. Gastrointest Endosc 2006

NBI of HGD in Barrett‘s

Prediction of HGDSensitivity 94%; Specificity 76%

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Tamai et al. Endoscopy 2006

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Tamai et al. Endoscopy 2006

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Differentiated

Undifferentiated

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HDTV & HD+

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Pentax-EPKi

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Pentax-EPKi

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Pentax-EPKi

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Autofluorescence & Video endoscopy

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Chromoendoscopy

Autofluorescence

Uedo et al. GI Endosc 2005

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Uedo et al. GI Endosc 2005

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ENDOMICROSCOPY

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Field of view: 475x475µmRange: 0-250µmLateral resolution: <1µm

Endomicroscopy

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Helicobacter pylori

Kiesslich et al., Gastroenterology 2005

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Final histology: poorly differentiated adenocarcinoma

Intestinale Metaplasia

Tumor vessel

Gastritis – Metaplasia - Cancer

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Well differentiated Adenocarcinoma

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Subtle Changes

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Normal gastric architecture Malignant transformation

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Signet ring cells

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Prospective blinded evaluation predicting gastric cancer

(132 locations)

Sensitivity 84%; Specificity 95%; Accuracy 80%

Inter-observer agreement by kappa statistics

for sites (antrum, corpus, cardia) presence of

intestinal metaplasia and cancer:

0.83, 0.89, and 0.63

Yeoh et al., DDW 2005

Gastritis – Metaplasia - Cancer

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MALT Lymphoma

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MALT-Lymphoma

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MALT-Lymphoma

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Endosonography & OCT

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Rösch, Gastrointest Clin North Am 1995

Accuracy 65-87%

Mini-Probes Endosonography

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Optical Coherence Tomography

OCT provides noninvasive, subsurface high-resolution imaging

of tissue microstructure.

In contrast to ultrasound, OCT utilizes light instead of sound

reflectivity, which provides a 10-fold higher resolution

Resolution 10-20 microns; Penetration depth <2.5mm

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OCT: Barrett Esophagus

Prediction of Barrett‘s Epithelium:

Sensitivity 97%; Specificity 92%

Poneros et al. Gastroenterology 2001Image: Rabenstein, Ell, Wiesbaden 2005

Barrett‘s epithelium

Squamous Epithelium

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Gastric Cancer?

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THERAPY

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Gotoda, Gastric Cancer 2007

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Classic Guidelines

Recurrence rates: 3-36%!Gotoda, Gastric Cancer 2007

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Crucial question

Lymphovascular invasion

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„Extended“ Guidelines

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ESD - Instruments

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Bleeding

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Perforation

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Perforation

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Conclusions

Diagnosis

Chromoendoscopy helps to characterize gastric lesions (size, type)

Magnifying endoscopy adds surface detail

HDTV (HD+) will replace conventional video endoscopy

Endomicroscopy – see histology in vivo

Therapy

EMR/ESD for selected cases and trained endoscopists

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THANK YOU

Early Gastric Cancer€¦ · Early Gastric Cancer 15.6.2007 Endosonography & OCT. University Mainz 15.6.2007 Early Gastric Cancer Rösch, Gastrointest Clin North Am 1995 Accuracy

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