Accuracy of high‐frequency catheter‐based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer

Abstract

The accuracy of EUS for the lesions with the extended indications was lower than that for the lesions with the accepted indications. In particular, lesions with ulceration and minute submucosal invasion should be carefully considered prior to endoscopic treatment by pretreatment EUS staging.

Is It Reasonable to Treat Early Gastric Cancer with Mucosal Infiltration and Well Differentiation by Endoscopic Submucosal Resection?

“…Although EUS has made it possible to greatly increase the diagnostic accuracy of tumor invasion distance, there still be errors of judgment. 30 In this regard, previous studies have reported that the accuracy of the preoperative workup for EGC was 90.5 %, 29,31,32 the results of the studies suggested that the staging was underestimated in the remaining 9.5 % of patients. In addition, LVI could only be recognized by surgery or endoscopic resection.…”

Benefit of pronase in image quality during EUS

“…Thus, it provides accurate evaluation of superficial and small submucosal tumors and diagnosis of early gastric cancer. 4 However, artifacts caused by gastric mucus can potentially affect visibility during conventional EUS and HFUS. This causes difficulty in evaluation of mucosal and superficial lesions.…”

Accuracy of endoscopic ultrasonography for diagnosing ulcerative early gastric cancers

“…In our study, the overall accuracy of EUS for ulcerative EGC was 68.6%, which is similar to previous reports. [9,16] However, the EUS accuracy rate for distinguishing between mucosal cancer and submucosal invasion improved to 77.1%. Although this accuracy rate was not a satisfactory result in our estimation, this result is still important, particularly when compared with those seen using conventional endoscopy (55.5%).…”

“…In the endoscopically resected cases, invasion depth was also classified into 2 groups: SM1 (penetration into the submucosal layer <500 μm from the muscularis mucosa), and SM2 (penetration >500 μm). [9,13] When the tumor invaded beyond submucosal layer, the lesions were classified as “advanced.”…”

“…[7–9] The main reason for this inaccuracy is generally considered to be fibrosis of the ulcer, which is seen on EUS as a hypoechoic lesion, similar to tumor invasion; EUS can thus not clearly distinguish it. This inaccuracy raises the question of the necessity of EUS in EGC with ulceration; some authors have reported that EUS is not necessary to determine the endoscopic resection for EGC, and that conventional endoscopy may be sufficient for determining the optimal therapeutic strategy.…”