| Theme | Recent Advances in Diagnosis and Treatment of Reflux Esophagitis | |
|---|---|---|
| Title | Efficacy of Magnifying Endoscopy for Differential Diagnosis of Esophago-Gastric Junctional Lesions | |
| Publish Date | 2004/11 | |
| Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
| Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
| Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
| Author | Kin-ichi Hotta | Department of Gastroenterology, Saku Central Hospital |
| Author | Ken Kominato | Department of Gastroenterology, Saku Central Hospital |
| Author | Shuko Morita | Department of Gastroenterology, Saku Central Hospital |
| Author | Manabu Takeuchi | Department of Gastroenterology, Saku Central Hospital |
| Author | Masaki Tanaka | Department of Gastroenterology, Saku Central Hospital |
| [ Summary ] | The differential diagnosis of lesions located on the esophago-gastric junction (EGJ) is sometimes difficult, because reflux esophagitis may cause inflammation on these lesions. Treatment with proton pump inhibitors (PPI) may improve inflammation, so the endoscopic and histological diagnosis can become easier. Conventional endoscopy gave us important information concerning color, shape and surface pattern of lesions. Magnified endoscopy gave us further information about pit and micro-vascular patterns. Therefore, diagnoses may be precise with magnified endoscopy. Fig. 4a-4e revealed a protuberant lesion on the EGJ. The lateral margin was unclear but the surface was irregular. Differential diagnosis was difficult with conventional endoscopy, but magnified endoscopy revealed a large villous pattern without irregular vessels, so the lesion was diagnosed as benign. The biopsy specimens showed only inflammation. Fig. 5a-5d revealed a small protuberant lesion. The margin was unclear and the surface was smooth. Magnified observation was impossible because the scope was of the conventional type, so the magnified endoscopy was planned two months later. The shape and size was same but the magnified endoscopy revealed irregular pit and micro-vascular patterns. The lesion was diagnosed as adenocarcinoma. Magnified endoscopy was useful for differential diagnoses, like this. Endoscopic submucosal dissection was performed and the pathological diagnosis was intramucosal adenocarcinoma. |
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