Premium
Probe‐based confocal laser endomicroscopy in the margin delineation of early gastric cancer for endoscopic submucosal dissection
Author(s) -
Park Jun Chul,
Park Yehyun,
Kim Hyun Ki,
Jo JeongHyeon,
Park Chan Hyuk,
Kim Eun Hye,
Jung Da Hyun,
Chung Hyunsoo,
Shin Sung Kwan,
Lee Sang Kil,
Lee Yong Chan
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13635
Subject(s) - medicine , endoscopic submucosal dissection , chromoendoscopy , dissection (medical) , resection margin , nuclear medicine , endomicroscopy , endoscopy , radiology , cancer , confocal , surgery , colorectal cancer , resection , colonoscopy , geometry , mathematics
Background and Aim We evaluated probe‐based confocal laser endomicroscopy (pCLE) in the margin delineation of early gastric cancer (EGC) for endoscopic submucosal dissection in comparison with white‐light imaging with chromoendoscopy (CE). Methods We conducted a prospective, randomized controlled study from November 2013 to October 2014 in a tertiary referral hospital. A total of 101 patients scheduled for endoscopic submucosal dissection due to differentiated EGC were randomized into pCLE and CE groups (pCLE 51, CE 50). Markings were made by electrocautery at the proximal and distal tumor margins, as determined by either pCLE or CE. The distance from the marking to the tumor margin was measured in the resected specimen histopathologically and was compared between the two groups by a linear mixed model. Results Among 104 lesions, 80 lesions with 149 markings (pCLE 68, CE 81) were analyzed after excluding undifferentiated EGCs ( n = 8) and unidentifiable markings ( n = 13). Although the complete resection rate showed no difference between the groups (94.6% vs 93.2%, P = 1.000), the median distance from the marking to the margin was shorter in the pCLE group (1.3 vs 1.8 mm, P = 0.525) and the proportion of the distance <1 mm was higher (43.9% vs 27.6%, P = 0.023) in the pCLE group. Finally, subgroup analysis with superficial flat lesions (18 lesions, 31 marking dots) showed a significantly decreased distance in the pCLE group (0.5 vs 3.1 mm, P = 0.007). Conclusions Among EGCs with superficial flat morphology, in which the accurate evaluation of lateral extent is difficult with CE, pCLE would be useful for more precise margin delineation.