Norichika Narimiya

Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer.

To avoid unnecessary lymphadenectomy in patients with cancer accurate diagnosis of the sentinel lymph node (SLN) is important.

The possibility of performing a limited resection and a lymphadenectomy for proximal gastric carcinoma based on sentinel node navigation

PurposeThis study examined the possibility of performing a limited resection and a lymphadenectomy with sentinel node navigation surgery (SNNS) for the treatment of proximal gastric carcinoma.MethodsThirty patients with cT1N0 (n = 23) and cT2N0 (n = 7) proximal gastric carcinoma that was located primarily in the U area (the upper third of the stomach) were enrolled. indocyanine green (ICG; 0.5 ml) was injected endoscopically into the submucosa of the four quadrants encompassing the cancer. Twenty minutes after injection, infrared ray electronic endoscopy (IREE) was used to identify the lymph nodes that were stained with ICG (sentinel nodes, SNs) around the serosa and surrounding fat tissue.ResultsOne hundred percent of the SNs were identified with our SNNS method. The most common location of SNs was No. 3 (T1: 78%, T2: 100%). The main route of lymphatic drainage was from No. 1 or No. 3 to No. 7 (T1: 95%, T2: 100%). In T1 cancer, Indocyanine green was not distributed to the right gastric area, and no patients had SNs in No. 5 or No. 8a. Four cT2 cancer patients had lymph node metastases, all of which were SNs. There were no cases of postoperative metastasis or recurrence.ConclusionsFor the cT1 proximal gastric carcinoma patients, limited dissection of the ICG tracer-positive lymphatic areas alone by SNNS using IREE may be acceptable. The main lymphatic drainage route of proximal gastric carcinoma is the left gastric artery area (Nos. 1, 3, and No. 7) and dissection of this area is important.

Tailoring treatment for early gastric cancer after endoscopic resection using sentinel node navigation with infrared ray electronic endoscopy combined with indocyanine green injection.

Background: This study evaluated the efficacy of sentinel node navigation surgery using infrared ray electronic endoscopy (IREE) combined with indocyanine green in patients after endoscopic treatments of early gastric cancer. Methods: 14 patients with early gastric cancer after endoscopic treatments were included. Each patient underwent sentinel node navigation surgery using IREE. Sentinel node detection rate, accuracy of sentinel node metastases and clinical efficacy including the presence or absence of recurrence were evaluated. Results: The intraoperative sentinel node detection rate was 100% (14/14), and accuracy for sentinel node metastases was 93% (13/14). Based on the results of sentinel node mapping, 2 patients received standard gastrectomy with D2 lymphadenectomy, and the remaining 12 patients underwent limited surgery with lymphatic basin dissection. After median follow-up of 32 months, no patients had tumor recurrence. Conclusion: The validity of limited surgery based on sentinel node navigation for early gastric cancer remains unclear because the results of a well-designed multicenter clinical trial of sentinel node mapping for gastric cancer have not yet been reported. However, this study suggests that sentinel node navigation surgery using IREE combined with indocyanine green is useful for early gastric cancer after endoscopic resection.

DIAGNOSTIC AND THERAPEUTIC USE OF INFRARED RAYS

In patients with esophageal varices, variceal lesions and surrounding superficial veins are clearly visualized with IREE.15 In patients who have undergone endoscopic injection sclerotherapy, IREE fails to visualize Form O varices containing stagnant blood or superficial mucosal erythema other than the red color sign, but clearly visualizes varices that drain blood. Therefore, IREE is useful for discriminating between these types of variceal lesions and for determining whether endoscopic injection sclerotherapy has been effective.16

Protective Effect of a Vasopressin-1 Selective Antagonist, OPC-21268, Against Ethanol-Induced Damage of The rat Gastric Wall

Since endogenous vasopressin has been reportedto be an aggressor in the gastric mucosa and avasoconstrictor in the gastric circulation, weinvestigated the gastric cytoprotective effects ofOPC-21268, a newly developed, nonpeptide, orally activevasopressin-1 receptor antagonist, on ethanol-inducedgastric injury in rats. The rats were treated withOPC-21268 or placebo 2 hr before ethanol administration, and the gastric mucosa was evaluatedmacroscopically for ulcer damage, and histologically forgastric mucosal injury. Gastric mucosal blood flow,erythrocyte volume, and erythrocyte velocity were alsomeasured in groups given saline, ethanol alone, andethanol after OPC-21268. To investigate The role ofsystemic or locally secreted vasopressin, we measuredplasma and tissue (gastric mucosa) vasopressinconcentrations after ethanol or vehicle administration.Prophylactic OPC-21268 treatment improved the gastriculcer score in a dose-dependent manner, and histologicalexamination demonstrated that the drug significantly ameliorated the gastric injury induced byethanol. The hemodynamic values obtained in theOPC-21268-treated and ethanol-treated group weResimilarto those in the saline control group, but values weresignificantly (P < 0.05) higher for gastric mucosal bloodflow and erythrocyte velocity and lower for erythrocytevolume compared to the group given ethanol alone. Plasmavasopressin concentrations were not significantly different in the control group and at 15, 30,and 60 min after administration of ethanol. However,ethanol administration caused a threefold increase ingastric tissue vasopressin level (P < 0.05) compared to the control group. These results suggestedthat OPC-21268 relieved congestive hyperemia in thegastric mucosa and ameliorated the mucosal injury causedby ethanol, probably as a result of inhibition of vasopressin-mediated actions on the stomach.The vasopressin involved was probably generated locallyin the gastric mucosa after ethanoladministration.

Findings of Portal Hypertensive Gastroenteropathy Using Infrared Electronic Endoscopy

Abstract: The aim of this study was to ascertain how and in what form portal hypertensivive gastroenteropathy affects the submucosal vasculature using an infrared electronic endoscope (IREE), which is capable of visualizing the submucosal vasculature. Subjects were 46 patients with liver cirrhosis (19 in Child‐Pugh class A, 21 in B, and 6 in class C). In 37 of 46 patients, the submucosal vasculature of the stomach was visualized using IREE and morphologic features were studied in relation to the severity of portal hypertensive gastropathy (PHG; none, mild and severe). In the remaining 9 patients, the submucosal vasculature of the rectum and sigmoid colon was observed with IREE. IREE images of blood vessels of the gastric submucosa demonstrated withered branch‐like vessels (35.1%), multiple dotted or spotted stains at terminations of branches (32.4%), vascular ectasia‐like circular stains (11%) and dilated tortuous venules of relatively large caliber around the cardia and in the upper region of the stomach (18.8%). This feature around the cardia was observed more frequently in patients with complications of gastric varices (55.6%). In relation to the severity of PHG, the incidence of withered branch‐like vessels was significantly higher in the severe gastropathy group than in the non‐gastropathy group. Dotted or spotted stains were most frequently observed in the severe gastropathy group. Visual examination of the colorectal mucosa with IREE noted withered branch‐like vessels in 7 of 9 cases. In 3 of 9 patients, dilated venules were seen running in the anorectal submucosa and joining the rectal varices. In conclusion, morphological changes due to congestion were found in portal hypertensive gastroenteropathy using IREE in submucosal venules of relatively large caliber and even in the venous plexus in the vicinity of the muscularis mucosa. (Dig Endosc 1999; 11: 144–149)

Gastric Ulcer Hemorrhage Treated by Endoscopic Hemostasis with Histoacryl

Abstract: We report a case of hemorrhagic gastric ulcer in which endoscopic injection of Histoacryl effectively achieved hemostasis. The patient was an 86‐year‐old woman with complaints of hematemesis and melena, and emergent endoscopic examination revealed fresh bleeding from the gastric ulcer. Neither endoscopic injection of Aethoxysklerol and ethanol nor clipping stopped the active bleeding, while the injection of Histoacryl produced an immediate hemostatic effect. Unfortunately, she died of pneumonia and heart failure seven days after this treatment. Autopsy revealed Histoacryl polymer localized in the gastric wall, but the gastric ulcer that had caused the massive bleeding was covered with exudate and the site of arterial rupture was unclear. The significant hemostatic effect of Histoacryl injection and the histological findings in this case suggest that this procedure may be useful for managing refractory hemorrhagic gastric ulcer.