“Para‐lesional” Saline Injection Method for Assessment of Small Gastric Cancers by Endoscopic Ultrasonography

Abstract

Abstract: Accurately diagnosing the depth of invasion in small early gastric cancers is essential for determining whether endoscopic resection of a lesion is indicated. It is often difficult, however, to demonstrate such small lesions by conventional endoscopic ultrasonography (EUS) which is considered to be a useful tool for assessing depth of invasion. To facilitate demonstration by EUS, we injected 2‐5 ml of saline into the submucosal layer at an appropriate point 1 ‐2 cm from the lesion. With the collection of saline serving as a guide, the lesion was demonstrable on the same EUS image (“para‐lesional” injection method). Using this method, we were able to evaluate all 12 of the small early gastric cancers we examined. Five of these lesions were endoscopically resected uneventfully after EUS examination. The accuracy of the diagnosis of vertical invasion with this method was 83% (10/12). Histologically, fibrotic changes were observed beside the lesion, but no EUS‐related effects were recognized beneath the lesion. The present results suggest that the “para‐lesional” injection method is useful for assessing small early gastric cancers by conventional EUS.