Clinical Trials Study
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World J Gastroenterol. May 7, 2014; 20(17): 5092-5097
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.5092
Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture
Yoshiyasu Kono, Ryuta Takenaka, Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Seiji Kawano, Yasushi Yamasaki, Koji Takemoto, Takayoshi Miyake, Shigeatsu Fujiki, Kazuhide Yamamoto
Yoshiyasu Kono, Yasushi Yamasaki, Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Yoshiyasu Kono, Yasushi Yamasaki, 2nd Department of Internal Medicine, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
Ryuta Takenaka, Koji Takemoto, Shigeatsu Fujiki, Department of Internal Medicine, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
Yoshiro Kawahara, Hiroyuki Okada, Keisuke Hori, Seiji Kawano, Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
Takayoshi Miyake, Department of Pathology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
Author contributions: Kono Y drafted the article, analyzed and interpreted the data; Takenaka R and Kawahara Y designed the research, revised the article for important intellectual content; Hori K, Kawano S, Yamasaki Y, Takemoto K and Miyake T analyzed and interpreted the data; Okada H, Fujiki S and Yamamoto K finally approved the article.
Correspondence to: Yoshiyasu Kono, MD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. hxnwq178@yahoo.co.jp
Telephone: +81-86-2357219  Fax: +81-86-2255991
Received: November 29, 2013
Revised: February 13, 2014
Accepted: March 4, 2014
Published online: May 7, 2014
Processing time: 158 Days and 12.9 Hours
Abstract

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.

METHODS: A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables.

RESULTS: En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC.

CONCLUSION: AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

Keywords: Acetic acid indigocarmine mixture; Early gastric cancer; Gastric adenoma; Reddish change; Endoscopic submucosal dissection

Core tip: A novel chromoendoscopy procedure using an acetic acid indigocarmine mixture (AIM) is effective for recognizing the margins of early gastric cancer (EGC). In some cases the color of the EGC area gradually becomes reddish after instillation of the AIM solution. The study shows that the sensitivity of AIM-chromoendoscopy (AIM-CE) in the diagnosis of EGC was significantly higher than that of white light endoscopy, but the specificity and accuracy were not. AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.