Diagnostic use of endoscopic mucosal resection in ''borderline'' gastric lesions unresolved with standard biopsies.
BACKGROUND
Endoscopic mucosal resection (EMR) of gastric superficial malignancies less than 20 mm in size and flat or slightly elevated without ulceration can be a definitive treatment, but its role in lesions of uncertain etiology or in which standard biopsies specimens fail to determine diagnosis is uncertain. EMR was performed in 7 patients previously diagnosed as having low grade dysplasia (Category 3 of Vienna classification) by standard biopsies on polypoid or flat gastric lesions.


METHODS
After day spraying with 0.2% indigo carmine and injection of 20 ml saline with adrenaline 1/20000, EMR of flat or sessile polyps (size between 5 to 15 mm) was performed by the Cap and Suction technique (Inoue).


RESULTS
In 3 patients a previous diagnosis of low grade dysplasia was changed into high grade dysplasia, in 1 patient adenocarcinoma was found at EMR histology. In 3 patients EMR confirmed diagnosis made with routine endoscopy biopsies and finally in 2 patients dysplasia was down-graded into intestinal metaplasia.


CONCLUSIONS
EMR may be considered in diagnostic gastric lesions with low grade dysplasia at standard biopsies (Category 3 of Vienna Classification of gastrointestinal neoplasia).
Gastroenterology Unit, ASL 5 Collegno, Turin.
D
D
Mazzucco
I
I
Venturini
E
E
Bollito
G
G
Gubetta
R
R
Suriani