surveillance | Acta Medica Marisiensis

Endoscopic Examination: a Present and Future Challenge

Boeriu Alina¹, Dobru Daniela¹, Mocan Simona², Pascarenco Ofelia³, Stoian M⁴, Boeriu C⁵

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, County Emergency Hospital, Tîrgu Mureș, Romania
3 Department of Gastroenterology, County Emergency Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, County Emergency Hospital, Tîrgu Mureș, Romania
5 Emergency Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

The detection and surveillance of patients with premalignant gastric lesions could lead to early detection and treatment of gastric cancer. These lesions are mostly diagnosed in random biopsy samples obtained during conventional endoscopy. New endoscopic techniques, such as magnification endoscopy, may help the detection of neoplastic lesions. In this case series, we intended to emphasize the current problems in the detection and surveillance of gastric neoplasic lesions in clinical practice. Four cases with gastritis-like appearance on conventional endoscopy were identified with gastric dysplasia or carcinoma on histopathologic evaluation. We discussed the subjective interpretation of endoscopic findings, the challenges in the surveillance of low-grade dysplasia and the contribution of magnifying endoscopy on diagnostic accuracy. The performance of endoscopic examination and surveillance could be improved by magnified chromoendoscopy with targeted biopsies. An understanding of diagnostic challenges of gastric dysplasia is crucial in clinical management.

Chromoendoscopy and Magnification for the Evaluation of the Intragastric Extent of Atrophic Gastritis and Intestinal Metaplasia

Boeriu Alina¹, Dobru Daniela¹, Pascarenco Ofelia², Mocan Simona³, Onișor Danusia²

1 Internal Medicine VII, Gastroenterology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Gastroenterology Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: The detection of intragastric extent and progression of atrophic gastritis and intestinal metaplasia are mandatory in order to quantify the risk of development of the gastric cancer. The aim of the study is to assess the clinical value of magnifying endoscopy and chromoendoscopy in the evaluation of the intragastric extent of atrophic gastritis and intestinal metaplasia.
Material and methods: We performed magnifying chromoendoscopy with methylene blue and we identified modified patterns corresponding to premalignant gastric lesions. We studied the intragastric extent of these lesions. Biopsy specimens were taken from modified areas in order to confirm the presence of atrophic gastritis and intestinal metaplasia.
Results: We identified specific pit patterns for atrophic gastritis and intestinal metaplasia. In 21 patients (30%) these lesions were confined to gastric antrum. In 7 cases (17.5%), lesions were extended in gastric corpus. These patients were selected for further endoscopic surveillance.
Conclusions: Magnifying endoscopy and chromoendoscopy allow the detection of intragastric extent of intestinal metaplasia and atrophic gastritis. This could help to a better selection of patients for surveillance endoscopy.