Endscopic Submucosal Dissection of a Heterotopic Gastric Mucosa in the Stomach: Report of a Case

A 38-year-old man with a submucosal tumor (SMT) at the anterior wall of the pylorus underwent upper gastrointestinal endoscopy. The tumor was 40 mm in diameter with a long stalk extending into the duodenal bulb. In addition, the long stalk had an ulcer with a blood vessel. Removal of this tumor was initially considered to be possible only by distal gastrectomy. However, endoscopic ultrasound (EUS) was subsequently proven to be a reliable investigative procedure for evaluating the lesion. The tumor was characterized by its origin in the second layer, and endoscopic submucosal dissection (ESD) was performed. En bloc resection of a 32 × 20 × 40 mm area of tissue with tumor-free lateral/vertical margins was accomplished without complication. Histopathological examination confirmed a heterotopic gastric mucosa. By immunostaining, the neoplasm was positive for MUC6 and negative for amylase and trypsin. In this case, EUS was used to investigate a heterotopic gastric mucosa that originated in the second layer, with no infiltration of the fourth layer under the tumor. Therefore, we performed successful ESD at the appropriate layer

A Comparison of Magnifying Chromoendoscopy Versus Narrow Band Imaging in the Diagnosis of Depth of Invasion for Early Colorectal Cancers

Although chromoendoscopy and narrow band imaging (NBI) are widely used in diagnosing the invasion depth of colorectal cancers, comparative studies of these modalities are lacking. This meta-analysis compared the performance of these two modalities in colorectal cancer diagnosis. MEDLINE, EMBASE, and Cochrane Library were searched for relevant original articles published up to December 20th, 2010. Major criteria for article inclusion were: (i) magnifying chromoendoscopy or NBI was used as a diagnostic modality and pit pattern or vascular pattern was used as a diagnostic classification; (ii) sensitivity and specificity were reported; (iii) absolute numbers of true-positive, false-positive, true-negative, and false-negative cases, or their equivalent, were provided; and (iv) pathology of biopsy, endoscopy, or surgical treatment was used as the reference standard. Sensitivity and specificity were pooled using a random effects model. Regression analysis was performed to compare the discriminatory power between chromoendoscopy and NBI by including a dummy variable. We made the assumption that a positive regression coefficient implied a better discriminatory power for NBI, and vice versa. Of 1846 screened articles, 16 fulfilled all inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.85 (95% CI: 0.82-0.87) and 0.80 (0.76-0.85), respectively, and specificity was 0.98 (0.97-0.99) and 0.98 (0.97-0.99), respectively. The regression coefficient for chromoendoscopy versus NBI was -0.02 (95%CI: -1.18-1.71). These results indicate that chromoendoscopy and NBI may have similar power for the diagnostic assessment of colonic neoplasms. However, other factors such as convenience, time, and cost still must be taken into account in making the final diagnostic choice

Clinical Efficacy of Endocytoscopy for Gastrointestinal Endoscopy

Endocytoscopy (EC) is a contact-type optical endoscope that allows in vivo cellular observation during gastrointestinal endoscopy and is now commercially available not only in Japan but also in Asian, European Union, and Middle Eastern countries. EC helps conduct a highly accurate pathological prediction without biopsy. Initially, EC was reported to be effective for esophageal diseases. Subsequently, its efficacy for stomach and colorectal diseases has been reported. In this narrative review, we searched for clinical studies that investigated the efficacy of EC. EC seems to accurately diagnose gastrointestinal diseases without biopsy. Most of the studies aimed to clarify the relationship between endocytoscopic findings of gastrointestinal neoplasia and pathological diagnosis. Some studies have investigated non-epithelial lesions or diseases, such as inflammatory bowel disease or infectious diseases. However, there are few high-level pieces of evidence, such as randomized trials; thus, further studies are needed