A 72-year-old man, having a past history of H. pylori eradication 7 years ago, underwent esophagogastroduodenoscopy (EGD) at a clinic. A depressed lesion on the gastric angle was detected and its pathological diagnosis was adenocarcinoma. Magnifying endoscopy with NBI (ME-NBI) demonstrated that the red depression, 20×8 mm in diameter, had regular microvascular/microsurface patterns, and the diagnosis was noncancer. Endocytoscopy (ECS), an ultra-magnifying endoscopy, showed that a part of the lesion had high-grade ECS atypia, and the diagnosis was cancer. The pathological diagnosis of the ESD specimen was 0-IIc, 3 mm, tub1, pT1a. H. pylori-eradicated cancers are often covered with epithelium with low grade atypia, which causes the difficulty of endoscopic diagnosis. In this case, ME-NBI could not show cancerous findings, but ECS could demonstrated cancerous findings, suggesting that ECS may be useful in the diagnosis of H. pylori-eradicated cancer.
