Clin Endosc.  2020 May;53(3):328-333. 10.5946/ce.2019.133.

Endoscopic Factors that Can Predict Histological Ulcerations in Early Gastric Cancers

• Lee J
• Kim BW
• Huh CW
• Kim JS
• Maeng LS

• KMID: 2502767
• DOI: http://doi.org/10.5946/ce.2019.133

Abstract

Background/Aims
Predicting histological ulceration in early gastric cancer (EGC) during endoscopic examination is crucial for endoscopists deciding on the treatment modality. The aim of this study was to investigate the endoscopic factors that can predict histological ulcerations in EGCs.
Methods
We retrospectively analyzed patients who underwent endoscopic submucosal dissection (ESD) for EGC. Clinical features and endoscopic characteristics of EGC such as location, histological differentiation, longest diameter, tumor morphology, mucosal break, converging fold, color change, and surface irregularity were reviewed. Histological ulceration was defined based on ESD specimens.
Results
A total of 633 EGC lesions from 613 patients were included and histological ulcerations were found in 90 lesions (14.2%). Presence of converging folds, tumor morphology, and color changes on endoscopic examination were related to histological ulceration in the univariate analysis and converging folds along with color changes were statistically significant factors in the multivariate analysis. Kaplan–Meier analysis showed that patients with histological ulcerations in EGCs tended to have higher marginal recurrence rates.
Conclusions
Mucosal breaks are not equivalent to histological ulcerations. Rather, the existence of converging folds and color changes during endoscopic examination suggest histological ulcerations. Endoscopists should consider these factors when they decide the treatment modality for EGCs.

Keyword

Early gastric cancer; Ulceration; Endoscopic submucosal dissection

Figure

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  Fig. 1. Representative images of endoscopic factors associated with histological ulcerations. (A) Mucosal break (white-dotted circle); (B) Converging fold (white arrows); (C) Color change (white-dotted circle); (D) Irregular surface (white-dotted circle).

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  Fig. 2. Recurrence rates. (A) Overall recurrence (n=82, p=0.401); (B) Metachronous recurrence (n=62, p=0.974); (C) Marginal recurrence (n=20, p=0.080).

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