Proposal for two strategies to prevent remnants of gastric cancers after endoscopic mucosal resections: fluorescein electronic endoscopy and rapid stump diagnosis based on pit patterns.
BACKGROUND
The aim of the present study was to establish strategies to prevent cancer remnants after gastric endoscopic mucosal resection (EMR).


METHODS
Whether surgical stumps could be diagnosed by pit patterns was examined on 38 well-fixed EMR materials. Furthermore, a rapid stump diagnostic method, which enables pit patterns of EMR material to be observed within 10 min, was developed. This rapid stump diagnosis was tested in 6 EMR cases of early gastric cancers, one of which was absolutely obscure to routine endoscopy. Fluorescein electronic endoscopy had been performed to reveal the extent of this cancer before EMR.


RESULTS
Adenocarcinomas showed irregular pit patterns that were significantly different from those of normal gastric mucosae. Among the 38 cases, all 20 EMR materials that were diagnosed as stump (-) and 5 that were diagnosed as stump (+), based on pit patterns, were confirmed by tissue sections to be stump (-) and stump (+), respectively. Six of the 13 EMR materials diagnosed as stump (+/-) by pit patterns were finally diagnosed as stump (+) by tissue sections. These data indicate that cancer remnants could be avoided if the stumps were judged positive or suspiciously positive just after EMR, and additional resections were continuously done until the stumps became negative. Rapid stump diagnosis based on pit patterns was successful in all 6 tested cases. The extent of the early gastric cancer that was absolutely obscure to routine endocscopy was clearly and exactly revealed by fluorescein electronic endoscopies done before EMR and subsequent rapid stump diagnosis.


CONCLUSIONS
It is probable that fluorescein electronic endoscopy, as a precise preoperative examination, and rapid stump diagnosis, based on pit patterns, will become effective strategies to prevent cancer remnants after EMR.
Bhunchet
Ekapot
E
Department of Pathology, Tsuchiura Kyodo General Hospital, 11-7 Manabeshinmachi, Tsuchiura, Ibaraki, 300-0053, Japan.
Shibata
Toshikatsu
T
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019793:Fluorescein / Q000008:administration & dosage; D006801:Humans; D008854:Microscopy, Electron; D018365:Neoplasm, Residual / Q000648:ultrastructure; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
D003287:Contrast Media; D019793:Fluorescein