Park JY, Jeon TJ. Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer. World J Gastroenterol 2022; 28(46): 6564-6572 [PMID: 36569274 DOI: 10.3748/wjg.v28.i46.6564]
Corresponding Author of This Article
Tae Joo Jeon, MD, PhD, Professor, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Seoul 01757, South Korea. drjtj@paik.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 14, 2022; 28(46): 6564-6572 Published online Dec 14, 2022. doi: 10.3748/wjg.v28.i46.6564
Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer
Ji Young Park, Tae Joo Jeon
Ji Young Park, Tae Joo Jeon, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul 01757, South Korea
Ji Young Park, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea
Author contributions: Jeon TJ and Park JY contributed to conception and design; Park JY contributed to acquisition of data (acquired and managed patients); Jeon TJ contributed to development of methodology; Jeon TJ and Park JY contributed to analysis and interpretation of data; Park JY contributed to writing and review of manuscript; Park JY and Jeon TJ contributed to study supervision.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Inje University Sanggye Paik Hospital (SGPAIK2021-10-019).
Clinical trial registration statement: This study is registered at “Clinical Research Information Service (https://cris.nih.go.kr)”. The registration identification number is KCT0007919.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Dr Ji Young Park and Tae Joo Jeon declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tae Joo Jeon, MD, PhD, Professor, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Seoul 01757, South Korea. drjtj@paik.ac.kr
Received: August 24, 2022 Peer-review started: August 24, 2022 First decision: September 2, 2022 Revised: September 22, 2022 Accepted: November 22, 2022 Article in press: November 22, 2022 Published online: December 14, 2022 Processing time: 106 Days and 5.1 Hours
ARTICLE HIGHLIGHTS
Research background
Although endoscopic ultrasound (EUS) is a method to predict the depth of invasion in early gastric cancer (EGC), it is still difficult to differentiate between T1a and T1b EGCs via EUS.
Research motivation
In particular, we considered a method to increase the accuracy of diagnosis for endoscopists who are beginning to perform EUS. It was thought that submucosal saline injection (SSI) during endoscopic mucosal resection may be helpful for examination because it can expand the submucosal layer.
Research objectives
The objectives of this study was to confirm whether SSI could be a method to improve the accuracy of EUS in distinguishing T1a and T1b lesions even in EGC and determine the feasibility of EUS for beginners.
Research methods
During March-April 2019, 24 endoscopically diagnosed EGC lesions in 24 patients were examined by EUS. All patients underwent standard EUS followed by EUS with SSI (EUS-SSI). Thereafter, endoscopic or surgical resection was performed within 7 days. T1a and T1b lesions were diagnosed based on the final pathology results after treatment. The diagnostic accuracy of EUS and EUS-SSI for T stage was compared.
Research results
Standard EUS identified 6 of 13 T1a cancer patients and 3 of 10 T1b cancer patients. Whereas, EUS-SSI identified 12 of 13 T1a cancer patients and 6 of 10 T1b cancer patients. In this study, SSI combined EUS was more accurate than EUS alone in diagnosing T1a and T1b lesions of EGC (75.0% and 37.5%, respectively).
Research conclusions
SSI improved the diagnostic accuracy of EUS in distinguishing between the T1a and T1b stages in EGC in this study. However, this needs to be confirmed in large-scale, prospective, randomized clinical trials in the future.
Research perspectives
In our study, SSI improved the diagnostic accuracy of EUS in distinguishing between the T1a and T1b stages in EGC. In particular, we suggest that beginners who are beginning EUS should try the EUS-SSI method when evaluating the depth of invasion of gastric cancer. However, our study is a clinical study conducted at a single institution, and the sample size is small. Therefore, a large-scale, prospective, randomized clinical trials for this are needed in the future.
