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

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15.6.2007Early Gastric Cancer

Unmask lesions

- Chromoendoscopy

- NBI

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

- OCT

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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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B G R

ConventionalFilter

B G R

NBIFilter

B

G R

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

Tumor

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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EMR

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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

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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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