title: Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.
authors.affiliation: 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.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Kono
authors.affiliation: 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.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Takenaka
authors.affiliation: 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.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.affiliation: 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.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.affiliation: 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.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.affiliation: 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.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawano
authors.affiliation: 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.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamasaki
authors.affiliation: 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.
authors.forename: Koji
authors.initials: K
authors.lastname: Takemoto
authors.affiliation: 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.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Miyake
authors.affiliation: 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.
authors.forename: Shigeatsu
authors.initials: S
authors.lastname: Fujiki
authors.affiliation: 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.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D016009:Chi-Square Distribution; D004396:Coloring Agents; D055088:Early Detection of Cancer; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007203:Indigo Carmine; D007564:Japan; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine; D019342:Acetic Acid
keywords: Acetic acid indigocarmine mixture; Early gastric cancer; Endoscopic submucosal dissection; Gastric adenoma; Reddish change