REPORT OF THREE CASES OF IIb EARLY GASTRIC CANCER DETECTED CLINICALLY -WITH SPECIAL REFERENCE TO CLUES TO THE DETECTION

Abstract

Three cases of the flat type of early gastric cancer (IIb) were detected preoperatively and the analysed clues to the detection were reported on 21 cases including 22 lesions of IIb-18 reported in the literature and 4 of our own . The majority of IIb lesions were found by endoscopy followed by biopsy, and it was extremely rare to find it by X ray examination. Abnormal tint of mucosa in endoscopy, redness and discoloration, constituted the chief marks of IIb lesion. The redness was visible in 12 of the 22 lesions, the discoloration in 7 and no change in 3. The redness tended to be observed in differentiated adenocarcinoma and the discoloration in undifferenciated adenocarcinoma. Four lesions of our own were detected by biopsy performed immediately after finding an abnormal tint of mucosa directly through the endoscope. Since the visible features of IIb through the endoscope could not be represented correctly on an endoscopic photograph in our cases, endoscopic observation offered the more important aid for the detection than reading the endoscopic photograph. Consequently, it is concluded that (1) endoscopy is the most preferable examination for the IIb detection, (2) direct observation through the endoscope immediately followed by biopsy serves more effectively as an detecting clue and (3) magnif ing endoscopy with the dyeing seems to be useful as a secondary examination.