title: Improved optical identification of laterally spreading type "0-IIb" gastric lesion with narrow band imaging magnification endoscopy.
abstract: Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric cancer. Accurate identification of tumor borders is crucial for curative ESD. Narrow band imaging magnification endoscopy (NBI-ME) has been effectively used for assessment of superficial gastric lesions; however, international experience in type "0-IIb" gastric lesions is limited. Successful endoscopic tissue characterization of laterally spreading type "0-IIb" early gastric cancer in a 74-year-old male with known type "0-IIa" lesion, using zoom NBI-ME, is reported. While the type "0-IIa" gastric lesion was clearly recognized by white light endoscopy and indigo carmine chromoendoscopy, the laterally spreading type "0-IIb" gastric cancer was only identified on the basis of NBI-ME malignant microvascular and mucosal microsurface pattern. Based on NBI-ME findings, accurate border marking approximately 1 mm apart from the demarcation line and completeen blocESD resection of both tumors was successfully succeeded. Recovery was uneventful. Histopathology showed moderately differentiated gastric adenocarcinoma in type "0-IIa" lesion and a small area of low-grade well-differentiated gastric adenocarcinoma in type "0-IIb" lesion. Conclusively, improved real-time optical identification of laterally spreading type "0-IIb" gastric lesion was achieved with NBI-ME.
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Nikolas
authors: N
authors: Eleftheriadis
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Haruhiro
authors: H
authors: Inoue
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Haruo
authors: H
authors: Ikeda
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Roberta
authors: R
authors: Maselli
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Manabu
authors: M
authors: Onimaru
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Akira
authors: A
authors: Yoshida
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Hiroaki
authors: H
authors: Ito
authors: Department of Pathology (Shigeharu Hamatani), Showa University Northern Yokohama Hospital, Japan.
authors: Shigeharu
authors: S
authors: Hamatani
authors: Digestive Disease Center (Nikolas Eleftheriadis, Haruhiro Inoue, Haruo Ikeda, Roberta Maselli, Manabu Onimaru, Akira Yoshida, Hiroaki Ito, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Japan.
authors: Shin-Ei
authors: SE
authors: Kudo
keywords: Narrow band imaging; early gastric cancer; endoscopic submucosal dissection; magnifying endoscopy