Hiroya Ueyama, MD, PhD1, Kenshi Matsumoto, MD, PhD1, Takashi Murakami, MD, PhD1, Takashi Yao, MD, PhD2, Akihito Nagahara, MD, PhD1
1Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan; 2Juntendo University, School of Medicine, Bunkyo-ku, Tokyo, Japan
Introduction: Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G) is used for qualitative diagnosis based on irregular microvascular architecture and micro-surface structure, but it is a static diagnostic algorithm using still images. On the other hand, magnifying endoscopy (ME) visualizes subepithelial microvascular red blood cell (RBC) flow in real time, but there has been no study focusing on the usefulness of microvascular blood flow in the diagnosis of early gastric cancer. We therefore evaluated microvascular blood flow using ME in the diagnosis of early gastric cancer.
Methods: Patients with early gastric cancer (EGC, n=5) or patchy redness (PR, n=5) underwent ME with blue light imaging (M-BLI, EG-L600ZW7, Fujifilm) at our hospital. A scale in 1-mm increments was visualized at 100× (3 frames) to 135× (4 frames) magnifications prior to examination, and gastric subepithelial microvascular blood flow in lesions and background mucosa videoed using M-BLI. Images were split into 30 frames/sec, and the mean blood flow rate was calculated by the mean movement distance of one tagging RBC. The blood flow rates in EGC, PR and background mucosa were compared between them. The ratio of blood flow rate (inside lesion/background mucosa) was compared between EGC and PR.
Results: EGC characteristics were as follows: mean age, 74.6 ± 7.8 years; male/female ratio, 2:3; previous history (hypertension: 1); Helicobacter pylori infection (current: 3, eradicated: 2); location (M: 4, L: 1); macroscopic type (IIa: 3, IIc: 2); histology (well- [n=4] and moderately differentiated [n=1] adenocarcinoma); and invasion depth (all M). PR characteristics were as follows: mean age, 68.2 ± 10 years; male/female ratio, 4:1; previous history (hypertension: 3); H. pylori infection (eradicated: 5); location (M: 2, L: 4). The mean blood flow rate was significantly slower in EGC (1881.4 μm/s; range 1406–2344) vs. PR (4162.6 μm/s; 3281–4688) or background mucosa (4265.7 μm/s; 3750–5156) (P < 0.01). The ratio of blood flow rate (inside lesion/background mucosa) was significantly lower in EGC (0.46; 0.38–0.50) than in PR (0.94; 0.88–1.10; P < 0.01).
Discussion: Early gastric cancer was associated with a significantly slower gastric subepithelial microvascular flow rate compared to patchy redness and background mucosa. Gastric subepithelial microvascular flow using magnifying endoscopy in real time may enable physiological diagnosis of early gastric cancer.
Citation: Hiroya Ueyama, MD, PhD; Kenshi Matsumoto, MD, PhD; Takashi Murakami, MD, PhD; Takashi Yao, MD, PhD; Akihito Nagahara, MD, PhD. P1753 - USEFULNESS OF BLOOD FLOW RATE OF SUBEPITHELIAL MICROVESSELS IN GASTRIC MUCOSA USING MAGNIFYING ENDOSCOPY IN THE STOMACH. Program No. P1753. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.