Study Of The Endoscopic Diagnosis And Treatment Strategies For Early Gastric Caner

Objective To investigate the benefits and feasibility of combining chromoendoscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) in predicting the need and maneuvers of therapeutic endoscopy for early gastric cancer by analysing the clinical data of patients who were diagnosed of early gastric cancer by Gastrointestinal Endoscopy Center and underwent endoscopic submucosal dissection (ESD) or surgery from January 2009 to September 2013 in Weihai Municipal Hospital.Methods 53 patients were selected. who were diagnosed of early gastric cancer by Gastrointestinal Endoscopy Center and underwent endoscopic submucosal dissection (ESD) or surgery from January 2009 to September 2013 in Weihai Municipal Hospital. They all underwent conventional endoscopy, chromoendoscopy, EUS and CT before therapy.Chromoendoscopy was used to determine the extent of disease. EUS was used to determine the lesion depth of invasion.EUS and CT were used to judge lymph node metastasis comprehensively.The treatment of early gastric cancer were ESD and surgery. Data were collected on the following parameters:endoscopic outcomes including conventional endoscopy, chromoendoscopy and EUS, CT data, therapeutic maneuvers, diagnostic yield. Comparing with the preoperative diagnosis and the postoperative pathological results and lymph node metastasis, it was to judge the value of chromoendoscopy, EUS and CT for early gastric cancer.Results (1)Indicarmine for early gastric cancer was 94.74%(36/38), ethylic acid in tandem with indicarmine for early gastric cancer was 100%(15/15).There was no significant statistically differences among the two groups (P>0.05). (2)The diagnostic accuracy of EUS was 79.24%(42/53) in mucosal cancer and the accuracy was 73.58% (39/53) in submucosal cancer. The total diagnostic accuracy of EUS for gastrointestinal early caner was 76.41%(81/106). There was no significant statistically differences among the two groups (P>0.05).10 cases (18.87%) were inadequate staging and 4 cases (7.54%) were excessive staging in EUS. (3) The accuracy of EUS in lymph node metastasis was 70.00%(14/20) and CT was 95.00%(19/20). There was significant statistically differences among the two groups (P<0.05). (4) There was no significant statistically differences in gender and age between ESD and surgery (P> 0.05).The complete resection rate was 86.11%(31/36) and the curative resection rate was 91.67%(33/36) in ESD. The follow-up results showed that all of 53 patients were alive, and there was no any recurrence.Conclusions (1) Chromoendoscopy can determine the extent of disease in early gastric cancer, and ethylic acid in tandem with indicarmine is similar to Indicarmine.(2) EUS can judge the depth of invasion in early gastric cancer, but there are excessive staging and inadequate staging. (3)CT is superior to EUS in judging lymph node metastasis.(4)The recent efficacy for early gastric cancer is similar between ESD and surgery, but it needs further study for the long-term effect of ESD.(5) It is incomplete by basing on only one of the above measures to determine whether to undergo endoscopic resection. It is necessary for the suspected early gastric cancer scheduled for ESD to perform the preoperative evaluation by combining chromoendoscopy, EUS and CT.