Effect of Endoscopic Epinephrine and Indigocarmin Spraying in the Detection of Horizontal Limits of Cancer Spread in Early Gastric Cancer

Authors: Mehmet Ali YERDEL, Masahiro AOYAMA, Akira GOUCHI, Kunzo 0RITA

Abstract: Conventional gastroscopy (CG) is not an excellent diagnostic modality in the diagnosis of early gastric cancer (EGC). We present a prospective study in which CG is compared with a new, sequential pharmaco-dye spraying (epinephrine (EP) / indigocarmin (IND)) method in order to define the diagnostic accuracies of both methods in the detection of the limits of horizontal spread in 15 consecutive EGC patients. We also assessed the diagnostic accuracy of EP/IND spray guided punch biopsies. Gastroscopies were performed and the lesions were photographed before and after EP/IND sprayings. Subsequently lesions were biopsied. Photographs were sketched with special care to assess the horizontal limits of spread. Postoperatively, specimens were re-sketched, and histologic precise limits of horizontal spread were established and these findings were recorded on the previous sketches for comparison. In all patients, EP spraying resulted in bleaching of the normal mucosa to a whitish color without any color change in the lesions. EP spraying raised the diagnostic accuracy rate from 60% to 93.3% in comparison to CG in the detection of horizontal spread limits. IND spraying failed to add significant information on the data obtanied by EP spraying. Regarding punch biopsies, EP/IND spray yielded correct tissue diagnosis in all patients. EP spraying alone seems to be an efficient method of horizontal spread detection. It is easier and less costly than the previously reported methods and also produces better results. Moreover, EP/IND spray may increase the diagnostic accuracy rate of punch biopsies in EGC.

Keywords: Stomach cancer, Endoscopic diagnosis, Early gastric cancer.