title: Effective optical identification of type "0-IIb" early gastric cancer with narrow band imaging magnification endoscopy, successfully treated by endoscopic submucosal dissection.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is currently considered the minimal invasive endoscopic treatment for early gastric cancer. Most superficial gastric neoplastic lesions are depressed type "0-IIc" (70-80%), while totally flat, classified as type "0-IIb" early gastric cancer, is rarely reported (0.4%). The aim of the present study was to assess the efficacy of narrow band imaging (NBI) magnification endoscopy in identifying type "0-IIb" early gastric cancer and ESD treatment with curative intention.
  
  
  METHODS
  Twelve of 615 (2%) patients (10 males, median 72 years), treated by ESD at our center, were diagnosed as type "0-IIb" gastric cancer. Ten had exclusively type "0-IIb", while two had combined types "0-IIb+IIc" and "0-IIa+IIb" gastric cancer. Initial diagnosis was made during screening gastroscopy, while NBI magnification endoscopy combined with indigo-carmine chromoendoscopy were also used.
  
  
  RESULTS
  White light endoscopy showed only superficial redness. One patient with signet-ring carcinoma showed whitish appearance. Indigo-carmine chromoendoscopy showed better visualization, while NBI magnification endoscopy revealed abnormal mucosal microsurface and microvascular findings which enabled border marking. ESD with curative intention was completed without complications. Histological examination showed complete (R0) resection, in 10 patients (83%). One patient with positive margins received additional surgery (8%). Mean procedure time was 149 (range 60-190) min. One to six years post-ESD all patients remain alive.
  
  
  CONCLUSIONS
  ESD is considered a safe and effective curative treatment for type "0-IIb" gastric cancer, resulting in long-term disease-free survival. NBI magnification endoscopy is effective for accurate optical identification and border marking of type "0-IIb" early gastric cancer.
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Nikolas
authors.initials: N
authors.lastname: Eleftheriadis
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Ηaruhiro
authors.initials: Η
authors.lastname: Inoue
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Onimaru
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Grace
authors.initials: G
authors.lastname: Santi
authors.affiliation: Department of Pathology (Shigeharu Hamatani), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Hamatani
authors.affiliation: Digestive Disease Center (Nikolas Eleftheriadis, Ηaruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Roberta Maselli, Grace Santi, Shin-ei Kudo), Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
keywords: Keywords Endoscopic submucosal dissection; early gastric cancer; narrow band imaging magnification endoscopy; type “0-IIb”