Diagnostic use of endoscopic mucosal resection in ''borderline'' gastric lesions unresolved with standard biopsies
Mazzucco, D.; Venturini, I.; Bollito, E.; Gubetta, G.; Suriani, R.
Minerva Gastroenterologica E Dietologica 48(2): 203-206
2002
ISSN/ISBN: 1121-421X PMID: 16489317 Document Number: 547623
Endoscopic mucosal resection (EMR) of gastric superficial malignancies less than 20 mm in size and flat or slightly elevated without ulceration can be a definitive treatment, but its role in lesions of uncertain etiology or in which standard biopsies specimens fail to determine diagnosis is uncertain. EMR was performed in 7 patients previously diagnosed as having low grade dysplasia (Category 3 of Vienna classification) by standard biopsies on polypoid or flat gastric lesions. After day spraying with 0.2% indigo carmine and injection of 20 ml saline with adrenaline 1/20000, EMR of flat or sessile polyps (size between 5 to 15 mm) was performed by the Cap and Suction technique (Inoue). In 3 patients a previous diagnosis of low grade dysplasia was changed into high grade dysplasia, in 1 patient adenocarcinoma was found at EMR histology. In 3 patients EMR confirmed diagnosis made with routine endoscopy biopsies and finally in 2 patients dysplasia was down-graded into intestinal metaplasia. EMR may be considered in diagnostic gastric lesions with low grade dysplasia at standard biopsies (Category 3 of Vienna Classification of gastrointestinal neoplasia).