Memduh ŞAHİN, Bahattin ÖZLÜ, Kıvılcım Eren ERDOĞAN, Alper SÖZÜTEK

I-Scan eşliğinde yapılan metilen mavisi işaretlemesinin preoperatif erken mide kanseri cerrahisindeki yeri

Günümüzde erken mide kanseri mukoza ve submukoza ile sınırlı gastrik adenokarsinom olarak tanımlanmaktadır. Uzak doğu ülkelerinde endoskopik yöntemle yapılan rezeksiyonlar ön planda olmasına rağmen dünya çapında en sık tedavi yöntemi hala cerrahi tedavidir. Olgumuz cerrahi olarak çıkarılan küçük boyutlu bir erken mide kanseri olgusunu kapsamaktadır. Endoskopik yöntemle tanı alan vakamıza operasyondan hemen önce işaretleme amacı ile milimetrik boyutlu lezyon etrafına I-Scan modu eşliğinde metilen mavisi skleroterapi iğnesi ile enjekte edildi. Ardından işaretlenen lezyonun operatif olarak optimal çıkarımı sağlandı. Sonuç olarak literatürde erken mide kanserleri için şu ana kadar net olarak ortaya konmamış metilen mavisi işaretlemesinin i-scan ile kombinasyonunun özellikle cerrahi yöntemin gerçekleştirilmesi ve küçük çaplı bu tür kanserlerin ameliyat sınır tespitinde yararlılık sağlaya- bileceğini düşünmekteyiz.

The role of i-scan directed metylen blue marking in the surgery of early gastric cancer

Currently, early gastric cancer can be identified as a group of malignan- cies limited to the mucosal and submucosal surface of the stomach. Although endoscopic methods are widely used in countries in the Far East, surgery is the prefered treatment option throughout the world. We report on a case of an early gastric malignancy, operated by limit- ed surgical borders. Preoperative I-scan directed metylen blue injection served to aid in an optimal and fast resection of the lesion. Endoscopic marking with I-scan supported metylen blue injection can assist in identification of small limited gastric cancers during an operation. Operative time can also be shortened with such methods.

PDF

___

1. Gotoda T. Endoscopic resection of early gastric cancer: the Japanese perspective. Curr Opin Gastroenterol 2006;22:561-9.
2. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg 1993;218:583-92.
3. Japanese Gastric Cancer Association Registration Committee, Maruyama K, Kaminishi M, Hayashi K, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry, Gastric Can- cer 2006;9:51-66.
4. Tajiri H, Ohtsu A, Boku N, et al. Routine endoscopy using electron- ic endoscopes for gastric cancer diagnosis: retrospective study of inconsistencies between endoscopic and biopsy diagnose, Cancer Detect Prev 2001;25:166-73.
5. Kawahara Y, Takenaka R, Okada H, et al. Novel chromoendoscopic method using an acetic acid-indigocarmine mixture for diagnostic accuracy in delineating the margin of early gastric cancers. Dig En- dosc 2009;21:14-9.
6. Nishimura J, Nishikawa J, Nakamura M, et al. Efficacy of i-Scan Im- aging for the Detection and Diagnosis of Early Gastric Carcinomas. Gastroenterol Res Pract 2014;2014:819395.
7. Märkl B, Arnholdt HM, Jähnig H, et al. A new concept for the role of ex vivo sentinel lymph no¬des in node-negative colorectal can- cer. Ann Surg Oncol 2010;17:2647-55.
8. Märkl B, Moldovan AI, Jähnig H, et al. Com¬bination of ex vivo sentinel lymph node mapping and methylene blue-assisted lymph node dissec¬tion in gastric cancer: a prospective and randomi¬zed study. Ann Surg Oncol 2011;18:1860-8.
9. Morita S, Katai H, Saka M, et al. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 2008;95:1131-5.
10. Mochiki E, Kamiyama Y, Aihara R, et al. Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years experience. Five years experience. Surgery 2005;137:317-22.
11. Lee JH, Yom CK, Han HS. Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 2009;23:1759-63.
12. Hiki N, Sano T, Fukunaga T, et al. Survival benefit of pylorus-pre- serving gastrectomy in early gastric cancer. J Am Coll Surg 2009;209:297-301.
13. Hoffman A, Basting N, Goetz M, et al. High-definition endosco- py with i-Scan and Lugols solution for more precise detection of mucosal breaks in patients with reflux symptoms. Endoscopy 2009;41:107-12.
14. Hoffman A, Sar F, Goetz M, et al. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neo- plasias compared with standard video colonoscopy: a prospective randomized controlled trial. Endoscopy 2010;42:827-33.
15. Qi QQ, Zuo XL, Li CQ, et al. High-definition magnifying endoscopy with i-scan in the diagnosis of Helicobacter pylori infection: A pilot study. J Dig Dis 2013;14:579-86.
16. Choi KS, Jung HY, Choi KD, et al. EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 2011;73:942-8.