Endoscopic characteristics of the early gastroesophageal junctional cancer: an analysis of 53 cases

Abstract

Objective To investigate the endoscopic characteristics of early gastroesophageal junctional(GEJ) cancer to improve the diagnostic procedure and techniques of endoscopy. Methods Data of 53 cases were retrospectively analyzed which were endoscopically and histologically diagnosed as early GEJ cancer in the gastrointestinal endoscopy center of the Second Affiliated Hospital of Zhengzhou University and No. 152 hospital of The PLA from November 2011 to July 2015. The lesion characteristics, features of white light endoscopy(WLE) and magnifying endoscopy with narrow band imaging(ME-NBI) and the clinicopathological features were analyzed. Results In early GEJ cancer, 67.9%(36/53) were classified as Siewert type 2, and 58.3%(21/36) located in the posterior wall below cardiac region(P=0.028). The main endoscopic type were Type 0-II(94.3%, 50/53), and Type 0-II accounted for 97.2%(35/36) of Siewert type 2 lesions. The lens barrel need to be reversed to view the whole pictures of Type0-II lesions, and positive lens barrel were needed in a small number of lesions. The lesion mucosa showed flushing(90.6%, 48/53), roughness(79.2%, 42/53), erosion(35.8%, 19/53) under the WLE. The submucosal microvessel were irregular or disappeared in 96.7%(29/30), the epithelial microstructure and pit patterns were irregular or disappeared in 90.0%(27/30), and boundaries of 86.7%(26/30) lesions were clear under the ME-NBI. The Barrett esophagus accompanied with Siewert type 1, 2 and 3 accounted for 83.3%(5/6), 11.1%(4/36) and 9.1%(1/11) respectively with significant difference(P=0.011). The ratio of the intestinal metaplasia with Siewert type 1, 2 and 3 lesions were 16.7%(1/6), 75.0%(27/36) and 63.6%(7/11) respectively, and there was significant difference between type 1 and type 2(P=0.011). Conclusion The Siewert type 2 is more common among the early GEJ cancer. Most of the lesions are shown the Type 0-II and located in the posterior wall below cardiac region. The mucosa lesions appear flushing, rough, erosion under WLE. The submucosal microvessel, epithelial microstructure and pit patterns appear irregular or disappeared, and lesions boundaries are clear under ME-NBI. Siewert type 1 tends to be complicated with Barrett esophagus, and Siewert type 2 and 3 tend to be complicated with intestinal metaplasia. Key words: Endoscopy; Esophagogastric junction; Early cancer; Narrow band imaging