1986 Volume 28 Issue 3 Pages 493-507
A clinical endoscopic observation was carried out to determine the extent of mucosal infiltration of flat or depressed early gastric cancers, by spraying epinephrine and prostagland in E1 (PEP). In effective cases of cancer lesions, their enhanced areas appeared red and were surrounded by discolored normal mucosa. To clarify the mechanism of the PEP, the ratio of vascular beds in cancerous mucosa to normal mucosa of the oral side [C/N ratio-U (upper layer), C/N ratio-T (total layer)] was caluculated using an image analysis system. A study was also made on the relation on the C/N ratio-U to endoscopic color of gastric cancer lesions and histological types.The results obtained were as follows:1. Endoscopic color of early gastric cancer was found to be determined by the C/N ratio-U rather than the C/N ratio-T (0.05<p<0.001).2. The C/N ratio-U showed values that increased in the order of signet ring, tubular, and poorly differentiated types.3. C/N ratio was significantly higher for effective cases of PEP than non-effective ones (p<0.001).4. PEP was useful for diagnosing the extent of early gastric cancer with reddened or no differed color before spraying vasoactivators.Based on the results, PEP appears to act on cancer lesions in two possible ways: 1) PEP constricts the arterioles in the abundunt vascular bed of cancerous mucosa causing stasis, pooling and refluxing of the blood flow; 2) the arterioles may be only partially constricted by PEP, but the blood still continues to flow in canceruos mucosa.
