Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

Abstract

Endoscopic diagnosis of gastrointestinal tumors consists of the following processes: (i) detection; (ii) differential diagnosis; and (iii) quantitative diagnosis (size and depth) of a lesion. Although detection is the first step to make a diagnosis of the tumor, the lesion can be overlooked if an endoscopist has no knowledge of what an earlystage 'superficial lesion' looks like. In recent years, image-enhanced endoscopy has become common, but white-light endoscopy (WLI) is still the first step for detection and characterization of lesions in general clinical practice. Settings and practice of routine esophagogastroduodenoscopy (EGD) such as use of antispasmodics, number of endoscopic images taken, and observational procedure are customarily decided in each facility in each country and are not well standardized. Therefore, in the present article, we attempted to outline currently available evidence and actual Japanese practice on gastric cancer screening using WLI, and provide tips for detecting EGC during routine EGD which could become the basis of future research.Key words: gastric atrophy, gastric cancer, Helicobacter pylori, Kimura-Takemoto classification, screening gastroscopy MEDICAL INTERVIEW PRIOR TO ESOPHAGOGASTRODUODENOSCOPY M EDICALINTERVIEW BEFORE esophagogastroduodenoscopy (EGD) is important in terms of the following two points. One is to confirm indication of the EGD and the other is to assess risk of examinees. Whether indication for EGD is to screen for early gastric cancer (EGC) or to make a diagnosis of a patient's symptoms or abnormal findings in other diagnostic examinations should be distinguished. In the screening endoscopy, the entire gastric mucosa is thoroughly observed to detect any suspicious findings for neoplasia, whereas only the presence of apparent lesions that may cause symptoms or abnormal image findings are investigated. Although endoscopy is usually intended to make a diagnosis of symptoms or abnormal findings in other diagnostic images, EGC are often found in patients with neither obvious symptoms nor abnormal findings in other diagnostic tests.1 Therefore, in high-risk patients, it is important to screen for EGC unrelated to symptoms or abnormal find-ings of other diagnostic tests during EGD. The examinee should be asked about status and history of eradication therapy of Helicobacter pylori (H. pylori), 2-4 family history of gastric cancer, smoking and drinking habits. [5][6][7][8] Another reason for the medical interview is to reduce 10 and an anti-foaming agent 11 reduces time and effort for washing out mucus or bubbles to improve quality of observation. A mixture of 4 mL anti-foaming agent (dimethicone, Gascon ® 20 mg/mL; Horii Pharmaceutical Industry, Osaka Japan), 20 000 U mucolytic agent (Pronase MS ® ; Kaken Pharmaceutical, Tokyo, Japan), and 1 g sodium bicarbonate dissolved in 50 mL water is given 10 min before the examination. 12Usefulness of a topical pharyngeal anesthetic is controversial although it is commonly used before gastroscopy. 13,14 UK data show that to...

How I do it: Flexible 3‐D endoscope for endoscopic submucosal dissection

“…GASTROINTESTINAL CANCERS REMAIN the commonest cancers worldwide . Recent development in image‐enhanced endoscopy (IEE) as well as the increased implementation of gastrointestinal cancer screening programs for colorectal and gastric cancers has led to earlier diagnosis of gastrointestinal cancers . With improvement in endoscopic recognition of early gastrointestinal cancers, as well as implementation of gastrointestinal cancer screening programs worldwide, there is an increasing trend in recognition of early gastric, esophageal and colon neoplasia.…”

“…1 Recent development in image-enhanced endoscopy (IEE) as well as the increased implementation of gastrointestinal cancer screening programs for colorectal and gastric cancers has led to earlier diagnosis of gastrointestinal cancers. 2,3 With improvement in endoscopic recognition of early gastrointestinal cancers, as well as implementation of gastrointestinal cancer screening programs worldwide, there is an increasing trend in recognition of early gastric, esophageal and colon neoplasia. Endoscopic submucosal dissection (ESD) has been developed to achieve en bloc resection for upper gastrointestinal neoplasia, 4,5 whereas colorectal ESD is increasingly carried out for treatment of laterally spreading tumors detected during screening colonoscopy.…”

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial

“…Improved visualization during EGD can be achieved by premedication with simethicone/Pronase . However, safety of the practice is under debate especially for those patients who undergo sedation during upper gastrointestinal endoscopy examination .…”

“…These substances may obscure important structural abnormalities and reduce the rate of early cancer detection. For this reason, in some countries, especially in Japan, premedication with antifoam/mucus agent has become standard practice to improve visibility during esophagogastroduodenoscopy (EGD) …”

The modern endoscopic investigation of the stomach with the application of the narrow-band imaging endoscopy and magnifying endoscopy: procedural techniques and diagnostic algorithms

“…Первоначально проводится подробный осмотр всех отделов желудка с целью поиска патологиче ских изменений, поражений или образований сли зистой оболочки [30]. Для этого требуется распра вить складки слизистой оболочки путем инсуффля ции воздуха или СО 2 , при необходимости дополни тельно отмыть слизистую оболочку от секрета с по мощью растворов пеногасителей и муколитиков, полностью «картировать» желудок (с помощью пря мого и инверсионного осмотра), а также использо вать дополнительные методики диагностики, такие как хромоскопия и узкоспектральная эндоскопия [31].…”