Gastric cancer
Early gastric cancer

Video Endoscopic Sequence 1 of 13.

Early gastric cancer

A 56-year-old female, who had been diagnosed in another clinic having a small cancer of the pre-pyloric antrum, had been offered a sub-tortal gastrectomy. A new endoscopy was performed and the biopsies confirmed the neoplasia.




For more endoscopic details download the video clips by clicking on the endoscopic images, wait to be downloaded complete then press Alt and Enter that you can appreciate the video in full screen.

All endoscopic images shown in this Atlas contain
video clips.

 

Early gastric cancer

Video Endoscopic Sequence 2 of 13.

15 days later, an endoscopic mucosectomy is performed



Endoscopic Mucosectomy

Video Endoscopic Sequence 3 of 13.

Endoscopic Mucosectomy

We used rubber band ligation with the same bands that is used for of esophageal varices with the same device which are sucked into a plastic hollow cylinder attached to the tip of the endoscope.The tissue is suctioned within the cylinder apparatus without infiltrating any solution.


 

Endoscopic Mucosectomy

Video Endoscopic Sequence 4 of 13.

Status post resection of Endoscopic Mucosectomy

With diathermy loop cautery as usual as a polypectomy, the resection was performed that video was not filmed because our technician forgot it.


Endoscopic Mucosectomy

Video Endoscopic Sequence 5 of 13.

Ablative therapy with argon plasma coagulator is used in a small fragment.




















Endoscopic Mucosectomy

Video Endoscopic Sequence 6 of 13.

Two hemoclips are placed

Endoscopic Mucosectomy

Video Endoscopic Sequence 7 of 13.

The second hemoclip is applied

Endoscopic Mucosectomy

Video Endoscopic Sequence 8 of 13.

The tissue fragment is removed that harboring a small intramucosal neoplasm, the histopathological study revealed free surgical borders.

 



Endoscopic Mucosectomy

Video Endoscopic Sequence 9 of 13.

The Surgical Specimen is seen

The Surgical Specimen 1.6x1x0.5 cm. With rubber band at the surgical edge.

 

 

 

 

 

To enlarge the image click on it.
 

 

Endoscopic Mucosectomy

Video Endoscopic Sequence 10 of 13.

The Surgical Specimen is seen

The Surgical Specimen 1.6x1x0.5 cm. With rubber band at the surgical edge.

 

 

 

 

 

 

Click on the image to enlarge

 

Endoscopic Mucosectomy

Video Endoscopic Sequence 11 of 13.

Under microscope there is chronic inflammation with extensive intestinal metaplasia complete type with a zone eroded by anterior biopsy with ulcerated intramucosal residual malignant glandular neoplasia in an extension not greater than 3 mm. Well differentiated with little infiltration to the lamina propria. Does not invade the muscularis mucosae or the submucosa. Lateral and deep surgical boundaries without lesion. There is no h. Pylori.

 

 

Click on the image to enlarge

Endoscopic Mucosectomy

Video Endoscopic Sequence 12 of 13.

Under microscope there is chronic inflammation with extensive intestinal metaplasia complete type with a zone eroded by anterior biopsy with ulcerated intramucosal residual malignant glandular neoplasia in an extension not greater than 3 mm. Well differentiated with little infiltration to the lamina propria. Does not invade the muscularis mucosae or the submucosa. Lateral and deep surgical boundaries without lesion. There is no h. Pylori.

 

 

 

 

Endoscopic Mucosectomy

Video Endoscopic Sequence 13 of 13.

Under microscope there is chronic inflammation with extensive intestinal metaplasia complete type with a zone eroded by anterior biopsy with ulcerated intramucosal residual malignant glandular neoplasia in an extension not greater than 3 mm. Well differentiated with little infiltration to the lamina propria. Does not invade the muscularis mucosae or the submucosa. Lateral and deep surgical boundaries without lesion. There is no h. Pylori.

 

 

Adenocarcinoma of the cardias and simultaneous carcinoma epidermoid of the larynx.

Video Endoscopic Sequence 1 of 27.

Double Primary Cancers.

Adenocarcinoma of the cardias and simultaneous carcinoma epidermoid of the larynx.

This is an 80 year-old male, That two years previously
presented this adenocarcinoma of the cardias.
The patient has a medical record of longstanding
gastroesophageal reflux disease and smoking.

The image
and the video clips display an obstructing adenocarcinoma.

The Epidemiology of Esophageal Cancer Has Changed Dramatically During The past Decade. The Incidence of Adenocarcinoma Associated With Barrett's metaplasia Is Rising Dramatically.

Squamous cell carcinoma of the larynx.

Video Endoscopic Sequence 2 of 27.

Squamous cell carcinoma of the larynx.

Four months previously, the patient presented with
hoarseness.

The etiology of oral epidermoide carcinoma is connected to
the abusive use of tobacco and alcohol, having been in
various studies demonstrated the effect synergetic of these
agents, the gastroesophageal reflux disease play role in
pathogenesis of the Squamous cell carcinoma of the larynx.
Double Primary Cancers.


Squamous cell carcinoma of the larynx.

Video Endoscopic Sequence 3 of 27.

Squamous cell carcinoma of the larynx.


 

Squamous cell carcinoma of the larynx.

Video Endoscopic Sequence 4 of 27.

Squamous cell carcinoma of the larynx.

We used a regular endoscopy forceps biopsy device to
optain the biopsies of the larynx cancer.


adenocarcinoma of the cardias.

Video Endoscopic Sequence 5 of 27.

Obstructing adenocarcinoma of the cardias.

Palliative treatment with argon plasma coagulator APC.

Esophageal cancer are detected every year. Progressive
dysphagia, initially to solids, later to liquids and secretions,
is one of the most frequent debilitating complaints. The
prognosis is dismal: more than 60% of patients are not
operable at the time of diagnosis.



















Debulking of the Tumor.

Video Endoscopic Sequence 6 of 27.

Debulking of the Tumor.

Palliative treatment with high power setting of argon
plasma coagulator APC.

The image and the video clip shows the APC catheter,
The APC probe produces a plasma arc that destroys tissue
to a depth of approximately 2 to 3 mm.

Palliation is the only realistic therapeutic option for these
patients. Available palliative treatment modalities include
chemotherapy, radiation therapy, esophageal dilation,
multipolar electrocoagulation, laser treatment, injection of
sclerosing agents, photodynamic therapy, and esophageal
endoprostheses.


Gastric Cancer

Video Endoscopic Sequence 7 of 27.

Recanalization of the Esophagus.

Argon plasma coagulation (APC) is an ablative endoscopic
technique. The patient received the therapy by four
different days with an interval of four days, After the third
treatment we passed to the gastric camera with endoscope
of 9.5 mm.



Gastric Cancer

Video Endoscopic Sequence 8 of 27.

Endoscopic appearance, after one week of the ablative therapy of the tumor.

Ablative therapy of the tumor for removing voluminous
masses of tissues and especially for recanalisations of
stenoses of gastrointestinal tract.



Gastric Cancer

Video Endoscopic Sequence 9 of 27.

Several session of ablative therapy was performed in order to overpass the cardias with the endoscope.

APC is a noncontact electrocoagulation device that useshigh-frequency monopolar current conducted to target tissuesthrough ionized argon gas (argon plasma). Electrons flow througha channel of electrically activated, ionized argon gas from theprobe electrode to the targeted tissue. Current density on arrivalat the tissue surface causes coagulation. Coagulation depth isdependent on generator power setting, flow rate of the argon gas,duration of application, and distance of the probe tip to thetarget tissue.

 

 

 

 

 

 


Gastric Cancer

Video Endoscopic Sequence 10 of 27.

Recanalization enabling passage of normal food.

After four session of high power setting of argon plasma
coagulator, we managed to have a suitable opening of the
cardia.


Gastric Cancer

Video Endoscopic Sequence 11 of 27.

After the recanalization, We took advantage of introducedthe endoscope to the gastric camera and to apply morecoagulation to the tumor.The argon arc contacts tissue closest to the electrode allowing foren face or tangential coagulation. With thermal coagulation oftissue, a thin, superficial, electrically insulating zone of desiccationand a steam layer (from the boiling of tissue) result, bothcontributing to limit carbonization and depth of coagulation. Theinsulating zone of desiccation produces increased electricalresistance in the treated area. This prompts the current to moveto another point on the tissue surface where resistance islower. However, with prolonged application carbonization,vaporization, and deep tissue injury can occur.

 

 

 

 


Esophageal Stent

Video Endoscopic Sequence 12 of 27.

View through the stent.

Successfully deployed Self-expanding stent in the
esophagus under fluroscopy control.
This image and the video clip were taken ten days after the
procedure.

Esophageal Z-Stent with dua anti-reflux valve is used to
maintain patency of malignant esophageal strictures and
to decrease esophageal reflux and aspiration.
ffective method of palliating dysphagia related to stricture
caused by malignant esophageal lesions.


Video Endoscopic Sequence 13 of 27 .

Anti-Reflux Stent

This endoscopic image displays Anti-Reflux valves of
the stent.

Self-expanding metal stents (SEMS) have become accepted
palliation for inoperable malignant esophageal obstruction.

 

Esophagus stent

Video Endoscopic Sequence 14 of 27.

A follow up endoscopy four weeks after the stent was
placed.

The Z-stent consists of a series of stainless-steel wire
cages bent into 2-cm-long segments in a "zigzag"
configuration. This urethane-covered stent is 18 mm in
diameter, with 25-mm flanged ends, and must be
compressed into a 28F catheter delivery system prior to
placement.The Z-stent has good expansile force, and a
new design incorporates an antireflux valve for bridging the
gastroesophageal (GE) junction.


Video Endoscopic Sequence 15 of 27 .

In this image and the video clip, the stent is appreciated,
emerging from the cardias. Retroflexed image, the
adenocarcinoma is constricting the cardias.


Video Endoscopic Sequence 16 of 27 .

More images and videos.

Esophageal stent placed four weeks previously,
retroflexed view of the stent emerging through the tumor
into the stomach.

 

Video Endoscopic Sequence 17 of 27 .

Fluroscopy image.

 

Video Endoscopic Sequence 18 of 27 .

Six months after the placement of the stent.

The patient had several episodies of hematemesis and
melena requiring multiple blood transfusion.

The image as well as the video clip show the superior third
of the stent.



Video Endoscopic Sequence 19 of 27 .

While repeated stenting is usually successful, debridement andlaser vaporisation are viable alternatives for proximal tumourovergrowth or ingrowth in the upper or middle third of theesophagus. Distal tumour growth or ingrowth at theesophago-gastric junction are best treated with a second stentRepeated treatment is justified, as survival following firstre-intervention is comparable to that after initial stenting,particularly in those patients who are able to undergochemotherapy or radiotherapy.



Video Endoscopic Sequence 20 of 27 .

Tumour Progression.

The gastric adenocarcinoma has overgrowth into the stent.
The image shows the site of the bleeding.


Video Endoscopic Sequence 21 of 27 .

The resource implications of re-intervention should be
considered in the overall assessment of palliative care.


Video Endoscopic Sequence 22 of 27 .

Argon Plasma Coagulator has been used to stop the
bleeding.

One of the indications of using APC is:
Treatment of obstruction resulting from tumor ingrowth
into the GI tract, particularly when the ingrowth has
occurred with a previously placed stent in the digestive
tract. to recanalize occluded or overgrown metal stents or
cut displaced metal stents.



Video Endoscopic Sequence 23 of 27 .

This image shows the exactly site of the hemorrhage which
emerge from the tumor.

 

Video Endoscopic Sequence 24 of 27.

More application of coagulation with Argon Plasma
Coagulator used to Debridement and stop the bleeding.
Debridement was suitable also for ingrowth.


Video Endoscopic Sequence 25 of 27.

View through the stent.

The antireflux valves apper to be destroyed for the gastric
acid and the tumor.


Video Endoscopic Sequence 26 of 27 .

Gastric Cardias in retroflexed view.

The adenocarcinoma is observed with no ulceration at this
site and the stent emerge from the esophagus.


Video Endoscopic Sequence 27 of 27 .

Gastric Cardias in retroflexed view.





Video Endoscopic Sequence 1 of 10.

This sequence shows the evolution of a gastric carcinoma
without a treatment.

A 28 year-old female with acute upper gastrointestinal
bleeding due to a gastric carcinoma in the posterior wall of
the gastric corpus near the fundus. A clot is covering the
ulcerated carcinoma. At that time the biopsies did not revea
malignancy.


Video Endoscopic Sequence 2 of 10.

The ulcerated carcinoma is seen without the blood clot, in
retroflexed view. At that time multiples fourth quadrant
were negative to malignancy.


Video Endoscopic Sequence 3 of 10.

40 days after, a second endoscopy was performed the
ulcer was active. The referring physician had only given
treatment for 15 days, but not signs of healing was
observed due to the lack of healing signs, we suspected for
malignancy, the biopsies remained negatives at that time.
The Patient was then instructed to have a new evaluation
in one month after the treatment and new multiples
biopsies, but the patient did not return.




Video Endoscopic Sequence 4 of 10.

The patient did not return until 21 months later.
An enormous ulcerated carcinoma was detected.
No weight loss was reported.


Video Endoscopic Sequence 5 of 10.

Gastric Carcinoma that invades the fundus and the
cardias.
At surgery, the pancreas was found to be infiltrated as
well as the celiac trunk. This are criteria of non-operability.
Patient was 29 year-old.


Endoscopic Sequence 6 of 10.

The cardias is infiltrated by the carcinoma.

 


Video Endoscopic Sequence 7 of 10.

We used therapeutical endoscopy using argon plasma
coagulator as a palliative therapy.
The argon plasma coagulator is suitable for palliative
tumor therapy.



Esophageal cancer

Video Endoscopic Sequence 8 of 10.

More images and video clips of therapeutical endoscopy
using argon as a palliative therapy.


Esophagus Cancer

Video Endoscopic Sequence 9 of 10.

The video clip displays the argon beam against the tumor.

 


Esophagus Cancer

Video Endoscopic Sequence 10 of 10.

Statust post using argon plasma coagulator for infiltrating
gastric adenocarcinoma to the esophagus.

 

Video Endoscopic Sequence 1 of 8.

Palliative treatment for gastric carcinoma that has caused dysphagia and partial obstruction at the cardias. The image and the video clip display a retroflexed image that have a infiltrating gastric carcinoma. The patient has liver metastasis. 

 



Esophageal cancer

Video Endoscopic Sequence 2 of 8.

The image and the video display the argon plasma
coagulation catheter with violet light.
Therapy with argon plasma coagulator (APC).
Argon Plasma Coagulation, or APC for short, is a new
method of electrocoagulation. As a result, it allows for the
non-contact application of electrical energy to achieve
tissue destruction or hemostasis (the ability to stop
bleeding). APC uses high frequency electrical current
delivered via ionized argon gas. This gas, being
ionized, allows for the conduction of electricity, thus
leading to the term "argon plasma"


Video Endoscopic Sequence 3 of 8.

The video clip displays the power of the argon plasma
coagulation onto the carcinoma.
We used a higher power setting of 120 W per APC session.



Video Endoscopic Sequence 4 of 8.

Another image and video clip in which they are observed
the power exerted by argon towards the tumor.



Video Endoscopic Sequence 5 of 8.

We recomended that you download the complete sequence
to apreciated this therapeutical treatment as a palliative.





Video Endoscopic Sequence 6 of 8.

More image and video clip of this treatment.
The APC probe produces a plasma arc that destroys tissue
to a depth of approximately 2 to 3 mm.


Video Endoscopic Sequence 7 of 8.

The argon beam is destroying some carcinomatous tissue.
Argon plasma coagulation (APC) is an ablative endoscopic
technique.


Video Endoscopic Sequence 8 of 8.

Cardias is infiltrated with carcinomatous tissue.
The image and the video clip displayed some nodules that
invades the esophagus.


Early Gastric Cancer of the Gastroesophageal Junction.

Video Endoscopic Sequence 1 of 11.

Early Gastric Cancer of the Gastroesophageal Junction.

A small nodule is observed.
This 83 year-old, male presented with chest pain and
dysphagia.
At endoscopy a small nodule was found, biopsy proved to
be an adenocarcinoma. 



Early Gastric Cancer of the Gastroesophageal Junction

Video Endoscopic Sequence 2 of 11.

Endoscopy of Early Gastric Cancer of the Gastroesophageal Junction

Mucosectomy

Barrett's Esophagus short segment and Adenocarcinoma of the Gastroesophageal Junction. 

 

Early Gastric Cancer of the Gastroesophageal Junction

Video Endoscopic Sequence 3 of 11.

A mucosectomy is being performed.

Endoscopic mucosectomy is a treatment mode for benign
and malignant gastric lesions. The prognosis of patients
with endoscopically treated early gastric cancer does not
differ from patients subjected to surgical gastrectomy,
when the indications for endoscopic mucosectomy are
respected.


Video Endoscopic Sequence 4 of 11.

Saline dextrosa 50% and adrenalin 1/100.000 was injected
into the submucosa.

Traditionally, Barrett's esophagus was defined as the presence of columnar mucosa extending >/= 3 cm into the tubular esophagus. This definition has evolved into the presence of any specialized columnar epithelium in the esophagus as it became known that the presence of intestinal metaplasia of any length was associated with an increased risk of esophageal adenocarcinoma. Barrett's esophagus was simply referred to as short-segment (< 3 cm) or long-segment (>/= 3 cm). Even this definition became problematic when it was discovered that as many as 1 in 5 Barrett's esophagus patients have this specific epithelium in the region of an otherwise normal-appearing squamocolumnar junction (ie, intestinal metaplasia of the gastric cardia). While this latter lesion is of little clinical relevance (as neither dysplasia nor cancer occurs to be appreciably increased in that setting), cancer and dysplasia do occur in the more numerous short-segment Barrett's esophagus patients as well as the less commonly encountered long-segment Barrett's patients. While the long-segment patients likely have greater risk for neoplasia compared with the short-segment patients, the risk in short-segment cases is still increased over that of the general population. Whether surveillance exams should be at different intervals for these 2 classifications of Barrett's based on length is controversial, and current guidelines treat them identically.



Esophageal cancer

Video Endoscopic Sequence 5 of 11.

Using endoscopic suction or saline injection to lift the lesion -bearing mucosa. Fitting a transparent cap on the tip of the endoscope can enhance the lifting power of suction. The cap has a rim to hold an open mucosectomy snare.

Endoscopic therapy has been employed for early-stage lesions in an attempt to avoid the high morbidity and mortality associated with current curative procedures such as esophagectomy.

Drawing up by Suction and Cutting This brings together several techniques which all necessi-tate drawing up the lesion by suction before the resection. This drawing by suction may be carried out with the aid of a plastic hood or of an elastic ligature unit.

Since the introduction of snare resection of pedunculated polyps (snare polypectomy) in the early 70's, many different devices and procedures were developed: strip-off biopsy, strip biopsy, with cap, and EMR with ligation.



Video Endoscopic Sequence 6 of 11.

The cap has a rim to hold an open mucosectomy snare.

Endoscopic mucosal resection, also known as
endoscopic resection, is defined as the resection of a
fragment of the digestive wall including the mucosal
membrane and the muscularis mucosae. This resection
most frequently re-moves a part or even all of the
submucosa.


Video Endoscopic Sequence 7 of 11.

Mucosectomy is a curative endoscopic procedure which
is intended for sessile benign tumors (principally the
adenomas or sessile villous tumors of the colon),
intraepithelial as well as intramucosal cancers (also called
in situ cancers).


Early Gastric Cancer of the Gastroesophageal Junction

Video Endoscopic Sequence 8 of 11.

There has been a growing body literature on the use of
endoscopic therapies in the treatment of early
gastroesophageal cancers. Accurate tumor staging is
crucial to select the appropriate candidates for endoscopic
treatment.


The malignant nodule has been falled out

Video Endoscopic Sequence 9 of 11.

The malignant nodule has been falled out

After selecting appropriate cases by endoscopy, followed
if possible by endosonography, mucosectomy facilitates
complete histological analysis of the reselected tumor, and
makes it possible to determine precisely the quality
(curative or not) of the treatment carried out, in contrast to
destructive techniques (laser, dynamic phototherapy,
electrocoagulation).


Early Gastric Cancer of the Gastroesophageal Junction.

Video Endoscopic Sequence 10 of 11.

The greatest amount of literature exists on EMR, a
modality that has the distinct advantage of providing a
complete histologic specimen for analysis.


Early Gastric Cancer of the Gastroesophageal Junction.

Video Endoscopic Sequence 11 of 11.

The nodule is been retrieved.

Mucosectomy can also be assisted by band ligation of
tissue (analogous to variceal ligation). Other accessories
include a ceramic ball-tipped needle knife to carve out
extensive flat growths. Piecemeal resection technique
allows the resection of a broad surface area, ensuring
complete removal of the lesion.

The resection margins were fulgurated with argon plasma
coagulation.


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