early gastric cancer€¦ · early gastric cancer 15.6.2007 endosonography & oct. university...
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![Page 1: 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](https://reader031.vdocument.in/reader031/viewer/2022011923/605d6ccfa9fa0862f44f771e/html5/thumbnails/1.jpg)
University Mainz
Early Gastric Cancer15.6.2007
Early Gastric Cancer
Ralf KiesslichJohannes Gutenberg University Mainz, Germany
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University Mainz
Early Gastric Cancer15.6.2007
DIAGNOSIS
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University Mainz
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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University Mainz
Early Gastric Cancer15.6.2007
CHROMOENDOSCOPY
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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
15.6.2007Early Gastric Cancer
Type I
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University Mainz
15.6.2007Early Gastric Cancer
Type IIa
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University Mainz
15.6.2007Early Gastric Cancer
Type IIa+IIc
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University Mainz
15.6.2007Early Gastric Cancer
Magnifying Endoscopy
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University Mainz
Early Gastric Cancer15.6.2007
High risk population
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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
15.6.2007Early Gastric Cancer
Shaw et al. Gut 2005
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University Mainz
Early Gastric Cancer15.6.2007
Filter Technology
NBI – FICE - SURFACE
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University Mainz
15.6.2007Early Gastric Cancer
B G R
ConventionalFilter
B G R
NBIFilter
B
G R
Narrow Band Imaging
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University Mainz
15.6.2007Early Gastric Cancer
Kara et al. Gastrointest Endosc 2006
NBI of HGD in Barrett‘s
Prediction of HGDSensitivity 94%; Specificity 76%
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University Mainz
15.6.2007Early Gastric Cancer
Tamai et al. Endoscopy 2006
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University Mainz
15.6.2007Early Gastric Cancer
Tamai et al. Endoscopy 2006
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University Mainz
15.6.2007Early Gastric Cancer
Differentiated
Undifferentiated
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University Mainz
Early Gastric Cancer15.6.2007
HDTV & HD+
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University Mainz
15.6.2007Early Gastric Cancer
Pentax-EPKi
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University Mainz
15.6.2007Early Gastric Cancer
Pentax-EPKi
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University Mainz
15.6.2007Early Gastric Cancer
Pentax-EPKi
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University Mainz
15.6.2007Early Gastric Cancer
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University Mainz
15.6.2007Early Gastric Cancer
Autofluorescence & Video endoscopy
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University Mainz
15.6.2007Early Gastric Cancer
Chromoendoscopy
Autofluorescence
Uedo et al. GI Endosc 2005
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University Mainz
15.6.2007Early Gastric Cancer
Uedo et al. GI Endosc 2005
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University Mainz
Early Gastric Cancer15.6.2007
ENDOMICROSCOPY
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University Mainz
15.6.2007Early Gastric Cancer
Field of view: 475x475µmRange: 0-250µmLateral resolution: <1µm
Endomicroscopy
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University Mainz
15.6.2007Early Gastric Cancer
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University Mainz
15.6.2007Early Gastric Cancer
Helicobacter pylori
Kiesslich et al., Gastroenterology 2005
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University Mainz
15.6.2007Early Gastric Cancer
Final histology: poorly differentiated adenocarcinoma
Intestinale Metaplasia
Tumor vessel
Tumor
Gastritis – Metaplasia - Cancer
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University Mainz
15.6.2007Early Gastric Cancer
Well differentiated Adenocarcinoma
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University Mainz
15.6.2007Early Gastric Cancer
Subtle Changes
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University Mainz
15.6.2007Early Gastric Cancer
Normal gastric architecture Malignant transformation
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University Mainz
15.6.2007Early Gastric Cancer
Signet ring cells
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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
Early Gastric Cancer15.6.2007
MALT Lymphoma
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University Mainz
15.6.2007Early Gastric Cancer
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University Mainz
15.6.2007Early Gastric Cancer
MALT-Lymphoma
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University Mainz
15.6.2007Early Gastric Cancer
MALT-Lymphoma
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University Mainz
Early Gastric Cancer15.6.2007
Endosonography & OCT
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University Mainz
15.6.2007Early Gastric Cancer
Rösch, Gastrointest Clin North Am 1995
Accuracy 65-87%
Mini-Probes Endosonography
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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
15.6.2007Early Gastric Cancer
Gastric Cancer?
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University Mainz
Early Gastric Cancer15.6.2007
THERAPY
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University Mainz
15.6.2007Early Gastric Cancer
Gotoda, Gastric Cancer 2007
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University Mainz
Early Gastric Cancer15.6.2007
EMR
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University Mainz
15.6.2007Early Gastric Cancer
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University Mainz
15.6.2007Early Gastric Cancer
Classic Guidelines
Recurrence rates: 3-36%!Gotoda, Gastric Cancer 2007
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University Mainz
Early Gastric Cancer15.6.2007
Crucial question
Lymphovascular invasion
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University Mainz
15.6.2007Early Gastric Cancer
Gotoda, Gastric Cancer 2007
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University Mainz
15.6.2007Early Gastric Cancer
„Extended“ Guidelines
Gotoda, Gastric Cancer 2007
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University Mainz
Early Gastric Cancer15.6.2007
ESD
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University Mainz
15.6.2007Early Gastric Cancer
Gotoda, Gastric Cancer 2007
ESD - Instruments
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University Mainz
15.6.2007Early Gastric Cancer
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University Mainz
15.6.2007Early Gastric Cancer
Bleeding
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University Mainz
15.6.2007Early Gastric Cancer
Perforation
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University Mainz
15.6.2007Early Gastric Cancer
Perforation
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University Mainz
15.6.2007Early Gastric Cancer
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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University Mainz
15.6.2007Early Gastric Cancer
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