USEFULNESS OF ACETIC ACID-INDIGOCARMINE MIXTURE FOR DIAGNOSIS OF HORIZONTAL MARGIN OF GASTRIC MUCOSAL TUMORS JUST BEFORE ESD

Abstract

Precise identification of the marginal line of gastric mucosal neoplasms is necessary for endoscopic curative resection by ESD. The use of an acetic acid-indigocarmine mixture (AIM) has been reported as safe and convenient for detecting gastric mucosal cancers and adenomas. It needs no special light instruments and magnifying endoscopic observation. We retrospectively investigated the usefulness of AIM-spraying for appropriate marking by detecting the marginal line of gastric mucosal neoplasms just before ESD. From June 2008 to February 2011, ESD was performed in 165 cases of gastric mucosal neoplasm in our hospital. Retrospectively, 8 endoscopists evaluated the marginal line of these cases by endoscopic images that were stored in the digital filing system. In 71 of the 165 cases in which the marginal line could not be decided by white light it was verified whether AIM-spraying made the marginal line clear and whether appropriate marking was performed according both endoscopic and pathological findings. A clear margin line was identified in 62 cases (87%) by AIM-spraying, and endoscopic findings agreed with pathological mapping. AIM-spraying can be a useful method for identifying gastric mucosal neoplasms and can be used to detect these horizontal margin lines just before ESD. In the other 9 cases, the lesions were not washed out by AIM-spraying. These cases were small depressed lesions or/and mucus stained lesions.