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This article discusses the use of texture and color enhancement imaging (TXI) in the detection of small gastric adenocarcinomas of fundic-gland type (GA-FGs). The study focuses on a man in his 60s who underwent endoscopic resection for multiple superficial GA-FGs. During a follow-up gastroscopy, new suspicious lesions were detected using TXI that were not visible on previous endoscopies. The study concludes that TXI can improve the detection of subtle gastric lesions like GA-FGs, which may be missed using conventional imaging techniques. [Extracted from the article]

Background: After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), delayed bleeding occurs in 1.7% to 38% of cases. Routine coagulation of all nonbleeding visible vessels (NBVVs) in post-ESD ulcers is currently performed as standard practice, but it cannot eliminate bleeding. An endoscopic Doppler US (DOP-US) probe system has possible benefits for the prediction of recurrent bleeding in peptic ulcer hemorrhage. Objective: To establish optimum use and evaluate feasibility of DOP-US for post-ESD ulcers. Design: Case series study. Setting: Cancer referral center. Patients: Eight patients with mucosal EGC larger than 2 cm without ulceration or scarring and 2 patients with EGC less than 3 cm with scarring. Interventions: We searched for a positive DOP-US signal (DOP-US+), which was defined as pulsatile sound at a depth of 1.5 mm, and NBVVs or areas with DOP-US+ were coagulated with hemostatic forceps. A multibending, double-channel videoendoscope that was fitted with a transparent hood was used. Main Outcome Measurements: Detectability of DOP-US signals in post-ESD ulcers. Results: One of 13 oozing bleeding sites, 24 (18%) of 136 NBVVs, and 7 areas without any bleeding stigmata had DOP-US+ and were coagulated until the signal became silent. One hundred twelve NBVVs (82%) and 8 adherent clots without DOP-US signals were left untreated. No delayed bleeding was experienced at 30 days. Median time required for Doppler examination was 34 minutes, but it improved to 18 and 19 minutes in patients 9 and 10, respectively. Conclusions: DOP-US might be helpful in the endoscopic management of post-ESD ulcers in EGC. Our setting and maneuver warrant further investigation to clarify whether DOP-US can reduce delayed bleeding and avoid unnecessary coagulation for NBVVs in post-ESD ulcers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Infrared endoscopy is used to visualize vessels in the GI tract. By applying this system, we developed a new method to visualize a bleeding point during endoscopic resection. OBJECTIVE: This study aimed to evaluate the ability of infrared endoscopy to detect a bleeding point during endoscopic resection and to elucidate the mechanism required for clear visualization of a bleeding point by in vitro color analysis. DESIGN: Observational case series. SETTING: A cancer-referral center. PATIENTS AND INTERVENTIONS: A total of 10 bleeding sites were observed during endoscopic resection of upper-GI cancers by infrared endoscopy after flushing with indocyanine green (ICG) solution (0.125 mg/mL water). MAIN OUTCOME MEASUREMENTS: Detection of bleeding points. RESULTS: Bleeding points were identified in all bleeding sites by infrared endoscopic viewing. Bleeding points were displayed in white, whereas, an ulcer bed was in blue and pooled blood was a blue-to-gray color. By in vitro color analysis, blood was white, blood twice diluted with ICG solution was dark blue, and blood 4-times diluted with ICG solution was light blue on infrared endoscopic views. Color differences with blood dilution were more obvious in an infrared endoscopic view compared with a conventional endoscopic view. Blood thickness, movement, and clotting did not influence the color differences. LIMITATIONS: Uncontrolled study. CONCLUSIONS: We reported a flushing method by which we could detect all bleeding points during endoscopic resection. Clear visualization of bleeding points comes from differences in blood and ICG concentration between spurting and pooled blood. [ABSTRACT FROM AUTHOR]

BACKGROUND: According to clinicopathologic studies, differentiated-type mucosal early gastric cancers without ulcer or ulcer scar have little risk of lymph-node metastasis, irrespective of tumor size. However, patients with large mucosal early gastric cancer have been subjected to surgery because conventional EMR methods could not resect large tumors en bloc. OBJECTIVE: To evaluate the feasibility and the efficacy of endoscopic submucosal dissection for treatment of early gastric cancers larger than 3 cm in diameter. DESIGN: Case series study. SETTING: Referral cancer center. PATIENTS: A total of 30 consecutive patients were enrolled with the following characteristics: diagnosis of differentiated-type early gastric cancer larger than 3 cm, lack of ulcerative change, no endoscopic evidence for submucosal invasion, and no evidence of lymph-node or distant metastasis (22 men and 8 women; median age, 69 years; median tumor size, 40 mm). INTERVENTIONS: Tumors were resected by endoscopic submucosal dissection with an insulated-tip knife. MAIN OUTCOME MEASUREMENTS: Complete resection, complication rate, and operation time. RESULTS: Complete resection was obtained in 23 of 30 cases (77%). Complications included hemorrhage (n = 4), perforation (n = 1), and pyloric stenosis (n = 1), but no severe complications occurred that required surgery or that led to major morbidity. Complete resection and complication rates improved in the last 10 cases (90% and 0%, respectively), though operation time was not shortened. LIMITATIONS: Small sample size and lack of controls. CONCLUSIONS: Endoscopic submucosal dissection when using the insulated-tip knife is feasible and efficacious for selected patients with mucosal early gastric cancer larger than 3 cm. [ABSTRACT FROM AUTHOR]