Clin Endosc.  2019 May;52(3):273-277. 10.5946/ce.2018.100.

Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer

• Takahashi
• Miura Y
• Osawa H
• Takezawa T
• Ino Y
• Okada M
• Lefor AK
• Yamamoto H

• KMID: 2449769
• DOI: http://doi.org/10.5946/ce.2018.100

Abstract

Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished from inflamed mucosa. We treated a patient with a small early gastric cancer that was difficult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, blue laser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from the surrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even with small-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosal dissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinoma localized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. This small early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.

Keyword

Early gastric cancer; Blue laser imaging; Small-caliber endoscopy; Endoscopic submucosal dissection

MeSH Terms

Adenocarcinoma
Biopsy
Depression
Endoscopes*
Endoscopy
Gastric Mucosa
Humans
Mucous Membrane
Stomach Neoplasms*

Figure

• 

  Fig. 1. (A) White light imaging with a small-caliber endoscope shows a small red area measuring 3 mm in diameter on the posterior wall near the gastric angle, which is not suspicious for gastric cancer. (B) Linked color imaging enhances the red lesion and the surrounding red portion. (C) Bright blue laser imaging reveals a discolored lesion measuring 10 mm around a central red area. (D) Blue laser imaging produces a high color contrast between the malignant lesion and the surrounding mucosa. Several irregular vessels are seen in the discolored lesion even with small-caliber endoscopy, suggesting early gastric cancer.

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  Fig. 2. Images obtained with a normal-caliber endoscope: (A) white light imaging and (B) linked color imaging cannot clearly reveal the site of the early gastric cancer (white arrows) because of the tangential view. (C) Blue laser imaging with middle magnification shows a brown malignant lesion surrounded by green mucosa (white arrows). (D) Blue laser imaging using high magnification shows irregular microvascular and irregular microstructural patterns on the mucosal surface.

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  Fig. 3. (A) The specimen resected by endoscopic submucosal dissection can be observed. (B) Histopathological evaluation of the resected specimen shows well-differentiated adenocarcinoma (black line) (hematoxylin & eosin [H&E], ×40) and (C) moderately-differentiated adenocarcinoma (black line) (H&E, ×40). (D) Magnified imaging of the square in (C) shows that microvessels are present in the intervening part of the superficial layer of the mucosa (H&E, ×100).

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