ABSTRACT
Background: Endoscopy plays an important role in the early detection of gastric neoplastic lesions, but different techniques lead to different diagnostic accuracy. Aims: To explore and compare the diagnostic value of conventional endoscopy with white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (ME-NBI) for early gastric neoplastic lesions. Methods: Patients suspected of having early gastric neoplastic lesions by WLI were collected consecutively from Jan. 2016 to Jun. 2018 at Shanghai Renji Hospital, and received ME-NBI within 2 weeks. The diagnosis based on WLI and ME-NBI was recorded, respectively. Targeted biopsy was re-performed in patients with suspected neoplastic lesion yet having no abnormalities in first biopsy. Patients with neoplastic lesions proved by pathology were treated with endoscopic resection or surgical operation and enrolled in the analysis. Using pathological diagnosis as gold standard, the diagnostic performance of WLI and ME-NBI for distinguishing intestinal-type gastric adenoma and early gastric cancer (EGC) was evaluated. Results: A total of 301 patients (301 lesions) were included, including 171 adenoma and 130 EGC. The interobserver agreement between two endoscopists was optimal for both WLI and ME-NBI observation (WLI: κ=0.70; ME-NBI: κ=0.81). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ME-NBI for distinguishing intestinal-type gastric adenoma from EGC were higher than those of WLI (89.2% vs. 76.9%, 90.6% vs. 71.9%, 87.9% vs. 67.6%, 91.7% vs. 80.4%, and 90.0% vs. 74.1%, respectively, all P<0.05). Conclusions: ME-NBI is superior to WLI in distinguishing intestinal-type gastric adenoma from EGC.
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Objective To assess the potential risk factors of canceration for intestinal?type gastric adenoma. Methods A retrospective study were performed on the data of 142 intestinal?type gastric adenoma patients who underwent endoscopic resection and was confirmed by postoperative histopathology at Digestive Endoscopy Centre, Shanghai Renji Hospital from May 2012 to December 2016. Potential risk factors for canceration of intestinal?type gastric adenoma were analyzed using univariate and multivariate Logistic analysis. Results A total of 142 intestinal?type gastric adenomas from 142 patients were collected in the study,comprised of 124 noncancerous lesions(low grade intraepithelial neoplasia)and 18 cancerous lesions (high grade intraepithelial neoplasia or carcinoma). Age 65 and older(P=0.03, OR=3.37, 95%CI:1.10?10.29),size equal or greater than 2 cm(P= 0.04, OR= 3.93, 95%CI: 1.07?14.49), and Helicobacter Pylori infection(P=0.04,OR=3.60,95%CI:1.07?12.14)were significantly associated with canceration in the univariate Logistic regression analysis. In the multivariate regression analysis,age 65 and older(P=0.03,OR=4.36,95%CI:1.17?16.24),size equal or greater than 2 cm(P=0.02,OR=5.79, 95%CI:1.28?26.12),and Helicobacter Pylori infection(P=0.03,OR=3.89,95%CI:1.15?13.59)were independent risk factors of canceration. Conclusion Intestinal?type gastric adenoma has varying degrees of intraepithelial neoplasia. Patient who is 65 years or older, or with Helicobacter Pylori infection, and lesion diameter of more than 2 cm are the potential risk factors of carceration.
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Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the ‘wait and see’ strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma.
Subject(s)
Adenoma , Argon , Classification , Plasma , Stomach NeoplasmsABSTRACT
Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.
Subject(s)
Aged, 80 and over , Female , Humans , Adenoma/complications , Follow-Up Studies , Gastritis/complications , Gastroenterostomy , Precancerous Conditions , Stomach Neoplasms/complications , Tomography, X-Ray ComputedABSTRACT
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been widely performed. However, procedure related-complications and the risk of tumor recurrence are limitations. We analyzed the clinicopathological characteristics of patients who underwent curative additional gastrectomy (gastrectomy) after ESD. METHODS: The clinical characteristics of cases underwent gastrectomy after ESD were retrospectively analyzed. RESULTS: Between January 2002 and August 2010, 1,512 cases underwent ESD for early gastric cancer (n=511) or adenoma (n=1,001). Thirty-two cases (2.1%) underwent gastrectomy after ESD. Thirty cases (2.0%) were EGC and 2 cases (0.1%) were adenoma. Extended indication, larger tumor size and piecemeal resection were risk factors for gastrectomy after ESD. According to the causes of gastrectomy, 13 cases underwent gastrectomy due to complications (40.6%; bleeding in 9, perforation in 4), and 19 cases based on pathological results (incomplete resection in 13, lymphatic invasion in 6). In cases with incomplete resection, the rate of residual tumor and lymph node metastasis after gastrectomy was 69.2% (75% lateral margin, 60% deep and 75% both) and 7.7%, respectively. Three (50%) of the 6 cases with lymphatic invasion had lymph node metatstasis. CONCLUSIONS: The causes of gastrectomy after ESD were the procedure-related complications, the incomplete resection and lymphatic invasion. For complete and curative ESD, endoscopists should try to minimize complications and determine the depth of invasion accurately before ESD.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenoma/pathology , Gastrectomy , Gastric Mucosa/pathology , Gastroscopy , Lymphatic Metastasis , Neoplasm Staging , Neoplasm, Residual , Retrospective Studies , Risk Factors , Stomach Neoplasms/pathologyABSTRACT
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is accepted as a standard treatment of early gastric cancer (EGC) and gastric adenoma. Occasionally, tumorous lesion is not found and pathologic discrepancies can occur after ESD. The aim of this study was to analyze the factors affecting the negative pathologic results after ESD. METHODS: We retrospectively reviewed the data from all patients with gastric neoplasm (276 EGC and 516 gastric adenomas) who were treated with ESD during past 3 years and enrolled the patients who had negative pathologic results. RESULTS: Out of 792 patients treated with ESD, 27 patients (3.4%) were eligible for inclusion. Among the 27 patients, factors affecting the negative pathologic results were, most commonly, the focal lesion (n=13, 48.2%) which was small enough to be removed completely during pre-ESD biopsy, followed by pathologic discrepancies (n=11, 40.7%) between pathologists and lastly the operator factor (n=3, 11.1%) dissecting incorrect lesions. Of the focal lesions, the initial pathologic diagnoses were adenocarcinoma in 11 cases (84.6%). In cases with pathologic discrepancies, all the pretreatment diagnoses were adenoma with low grade dysplasia. In cases caused by operator factors, intestinal metaplasia was accompanied by elevated adenoma in all cases. CONCLUSIONS: To decrease negative pathologic results after ESD, an endoscopist should perform ESD after sufficient communication with pathologists, especially for adenoma with low grade dysplasia, and choose correct lesion, especially located at the antrum and associated with intestinal metaplasia. The possibility of total removal of small lesions even by forcep biopsy should be considered.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/diagnosis , Dissection , Gastric Mucosa/pathology , Gastroscopy , Retrospective Studies , Stomach Neoplasms/diagnosisABSTRACT
We report a case of a 59 year-old male presenting with upper gastrointestinal symptoms characterized by epigastric pain. Endoscopic biopsies were diagnostic of adenoma with high-grade dysplasia and focal mucosal invasion by well-differentiated intestinal type adenocarcinoma, which is successfully treated with mucosectomy. We discuss indications for this technique and prognostic factors associated with the macroscopic classification, histological type, size and depth of cancer invasion.
Se presenta caso de paciente masculino de 59 años con sintomatología digestiva alta caracterizada epigastralgia. Las biopsias endoscópicas son diagnósticas de lesión de tipo adenoma con displasia de alto grado y foco de invasión mucosa por Adenocarcinoma bien diferenciado de tipo intestinal, el cual es tratado exitosamente con mucosectomía. Se discuten indicaciones de ésta técnica y factores pronóstico asociados con la clasificación macroscópica, tipo histológico, diámetro de la lesión y profundidad de invasión cancerosa.
Subject(s)
Humans , Male , Middle Aged , Adenoma/surgery , Adenoma/pathology , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Endoscopy, Gastrointestinal/methods , Gastric Mucosa/surgeryABSTRACT
BACKGROUND/AIMS: DNA double strand break (DSB) is one of the critical types of DNA damage. When unrepaired DSB is accumulated in the nucleus of the cells having mutations in such genes as p53, it will lead to chromosomal instability and further more to mutation of tumor-activating genes resulting in tumorogenesis. Some of malignant cancers and its premalignant lesions were proven to have DSB in their nuclei. The aim of this study was to define the differences in expression of 53BP1 and gamma-H2AX, the markers of DSB, among normal, gastric adenoma, and gastric adenocarcinoma tissues. METHODS: Tissue microarray was made with the tissues taken from 121 patients who underwent gastrectomy for gastric adenocarcinoma, and 51 patients who underwent endoscopic mucosal resection for gastric adenoma. Immunochemical stain was performed for the marker of DSB, 53BP1 and gamma-H2AX in the tissue microarray. The normal tissues were collected from histologically confirmed tissues with no cellular atypia obtained from the patients with gastric adenocarcinoma. RESULTS: In gastric carcinoma cells, 53BP1 and gamma-H2AX were highly expressed as compared to normal epithelial cells and gastric adenoma (p<0.01). There were no differences in the expression of 53BP1 and gamma-H2AX between normal epithelium and gastric adenoma. The expression of 53BP1 in the adenoma with grade II and III atypism was more elevated than in those with grade I atypism. The expression of 53BP1 and gamma-H2AX were not significantly different according to the clinicopathologic parameters in the patients with gastric adenocarcinoma. CONCLUSIONS: The DSB in DNA seems to be associated with the development of gastric adenocarcinoma, but does not affect the premalignant adenoma cells.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/genetics , Adenoma/genetics , Chromosomal Instability , DNA Breaks, Double-Stranded , Histones/metabolism , Intracellular Signaling Peptides and Proteins/metabolism , Neoplasm Staging , Stomach Neoplasms/geneticsABSTRACT
BACKGROUND/AIMS: It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma. METHODS: We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features. RESULTS: Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p or =50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma. CONCLUSIONS: The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenoma/diagnosis , Age Factors , Colonoscopy , Colorectal Neoplasms/diagnosis , Diabetes Mellitus/diagnosis , Prevalence , Retrospective Studies , Risk Factors , Sex Factors , Stomach Neoplasms/diagnosisABSTRACT
BACKGROUND/AIMS: The discrepancy of the histopathological diagnosis between endoscopic forcep biopsy, surgery and endoscopic mucosal resection (EMR), has been reported on in a previous study. We compared the results of endoscopic forcep biopsy and the histopathologic diagnosis after performing endoscopic submucosal dissection (ESD). METHODS: We retrospectively reviewed 434 lesions for which we were able to compare the post-ESD histopathologic results with the endoscopic biopsy. RESULTS: 1) Of the 14 lesions that showed chronic gastritis or atypia by endoscopic biopsy, 9 were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 2) fifty one of 141 lesions that showed low grade dysplasia on the endoscopic biopsy were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 3) Of the 60 lesions that showed high grade dysplasia on the endoscopic biopsy, 46 were diagnosis with carcinoma in situ or adenocarcinoma after ESD. CONCLUSIONS: The discrepancy of the histopathological diagnosis was found between ESD and forcep biopsy. In light of these results, if a lesion that is suspected to be EGC, although it is not diagnosed by endoscopic biopsy, then it should be confirmed by ESD.
Subject(s)
Adenocarcinoma , Biopsy , Carcinoma in Situ , Gastritis , Light , Retrospective Studies , Surgical InstrumentsABSTRACT
A gastric carcinoid is a rare disease that accounts for only 0.3% of all primary gastric tumors. It can be multiple or occur with other types of tumor. However, there has been a recent increase in incidence. While carcinoids of the appendix and rectum are accompanied by adenoma or adenocarcinoma, a gastric carcinoid rarely occurs with an adenocarcinoma, particularly with a gastric adenoma. We encountered a case of a gastric adenoma and carcinoid mixed as a composite tumor, which became a lesion. The lesion resembled a type IIc early gastric cancer at the endoscopic examination and was removed by an endoscopic mucosal resection. We report a composite tumor of the gastric antrum composed of areas of adenoma and carcinoid, with an analysis of the histological components by immunohistochemical staining. Microscopically, the lesion was composed of a gastric adenoma and carcinoid as a composite tumor.
Subject(s)
Adenocarcinoma , Adenoma , Appendix , Carcinoid Tumor , Incidence , Pyloric Antrum , Rare Diseases , Rectum , Stomach NeoplasmsABSTRACT
We report a case of gastric adenoma which was found incidentally on 18F-FDG PET/CT study for cancer screening in asymptomatic patient. It showed focal and intensely increased FDG uptake in the antrum of stomach. On the gastroduodenoscopy, it showed flat elevated lesion with irregular margin. Histologically, the lesion was confirmed gastric adenoma with high grade dysplasia and removed by endoscopic mucosal resection.
Subject(s)
Humans , Adenoma , Early Detection of Cancer , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , StomachABSTRACT
BACKGROUND/AIMS: We wanted to investigate of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by endoscopic submucosal dissection (ESD). METHODS: 69 gastric adenomas and 38 early gastric cancers (EGC) that were treated by ESD from July, 2004 to February, 2006 were reviewed to analyze the relation between the histologies of the endoscopic biopsy and the resected specimen. RESULTS: The discrepancy rate between the histology of the endoscopic biopsy and the resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Among the 43 cases of low grade dysplasia, 6 cases (14%) were confirmed as gastric cancer after ESD. CONCLUSIONS: The histologic discrepancy between the endoscopic biopsy and resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Though the endoscopic biopsy may reveal low grade dysplasia, gastric adenoma should be removed by endoscopic mucosal resection because of the histological discrepancy between the endoscopic biopsy and the resected specimen.
Subject(s)
Adenoma , Biopsy , Stomach NeoplasmsABSTRACT
PURPOSE: Cancer is a genetic disease caused by alterations in key regulators of cell growth and cell turnover. We investigated apoptotic cell death and cell proliferation in gastric adenomas and adenocarcinomas. MATERIALS AND METHODS: The TdT-mediated dUTP-biotin nick end labelling (TUNEL) method and immunohistochemistry for Ki-67 were performed, using paraffin-embedded tissues of 41 gastric adenomas and 100 gastric adenocarcinomas. These results were compared with histopathologic parameters. RESULTS: The Ki-67 labelling index was higher in adenocarcinomas than in adenomas and the apoptotic index was higher in adenomas than in adenocarcinomas. There were no significant difference between the apoptotic index/Ki-67 labelling index and clinicopathological parameters. CONCLUSION: We propose that cell proliferation is more closely associated with gastric adenocarcinomas than apoptosis is, but that neither has any clinical significance as a prognostic factor in gastric adenocarcinomas.
Subject(s)
Adenocarcinoma , Adenoma , Apoptosis , Cell Death , Cell Proliferation , ImmunohistochemistryABSTRACT
BACKGROUND: Endoscopic mucosal resection (EMR) is now widely accepted as a useful treatment method for gastric adenoma and early gastric cancer (EGC) because of its minimal invasiveness and satisfactory post-procedure results. The purpose of this study is to define the follow-up results and usefulness of EMR. METHODS: We analyzed 54 cases from June 2000 through September 2004. Endoscopy with histological examination was carried out every 3 months for 1 year after EMR. RESULTS: The patients consisted of 42 men and 12 women, and the mean age was 60 years old. The histological results were 42 gastric adenoma and 12 EGC cases. There were 9 cases that had the histological diagnosis changes after EMR. Complete resections was performed for 48 cases and the en block resections were 33 of 34 cases (97%) and piecemeal resections were done in 15 of 20 cases (75%). Recurrence was seen in 4 cases (7.1%), and the mean recurrence period was 7 months. There were 3 gastric adenomas of 42 cases (7.1%), one case of EGC of 12 cases (8.3%), one en block resection of 34 cases (2.9%) and three piecemeal resections of 20 cases (15%). CONCLUSIONS: EMR is a safe and useful treatment method for gastric adenoma and EGC. However, EMR has some limitations that EGC may have lymph node metastases or multiple tumors. So, periodic follow-up is very important. As we acquire more clinical experience, EMR may be accepted as the standard treatment method for gastric adenoma and EGC.
Subject(s)
Female , Humans , Male , Middle Aged , Adenoma , Diagnosis , Endoscopy , Follow-Up Studies , Lymph Nodes , Neoplasm Metastasis , Recurrence , Stomach NeoplasmsABSTRACT
BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection can lead to gastric adenoma and carcinoma through atrophic gastritis and intestinal metaplasia. Imbalance between apoptosis and proliferation may play a role in gastric carcinogenesis. We tried to investigate H. pylori infection rate, grade of gastritis, environmental risk factors, expression rate of apoptosis and cell proliferation in mucosa adjacent to tumor, and we also tried to find significant factors associated with gastric carcinogenesis. METHODS: Endoscopically diagnosed twenty cases of intestinal type gastric carcinoma, 20 cases of gastric adenoma, and 40 cases of control (normal or gastritis) were enrolled. H. pylori infection rate, histologic grading, apoptosis and immunohistochemical stain (Ki-67 and p53) to check mucosal proliferation were done in endoscopically biopsied tissues at antrum and body at least 2 cm apart from adenoma or carcinoma. RESULTS: In three groups, H. pylori infection rates were not significantly different. In the multivariate analysis, only atrophy of gland was a significant risk factor for adenoma compared to control group (OR 3.7). Intestinal metaplasia in antrum and alcohol drinking were significant risk factors for carcinoma compared to control group (OR 4.4 and 4.9 respectively). Expressions of apoptosis, Ki-67 and p53 were not significantly different in three groups. CONCLUSIONS: Intestinal metaplasia in antrum and alcohol drinking are significant risk factors for gastric carcinoma. Degree of mucosal proliferation and apoptosis in gastric mucosa adjacent to tumor are not significantly different in three groups.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/microbiology , Adenoma/microbiology , Apoptosis , Cell Proliferation , English Abstract , Gastric Mucosa/pathology , Gastritis/microbiology , Helicobacter Infections/complications , Helicobacter pylori , Risk Factors , Stomach Neoplasms/microbiologyABSTRACT
BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. It has been widely accepted as a useful method due to its minimal invasiveness, safety and satisfactory result. The purpose of this study was to identify the factors affecting the recurrence after EMR. METHODS: Three hundred twenty adenomas in 297 patients were treated by EMR from January, 1991 until July 2003. Among those, 197 lesions in 184 patients that could have been followed-up were analyzed retrospectively. RESULTS: The mean follow-up period was 15.0 (1~89) months. Of the 197 lesions, there were 35 recurrences (17.7%). The recurrence rate was higher in lesions associated with severe mucosal atrophy and intestinal metaplasia in surrounding mucosa (p=0.035). Other factors showed no statistically significant difference in recurrence rate. CONCLUSIONS: In this study, we concluded that the presence of intestinal metaplasia and severe atrophic background mucosa were related to the recurrence of gastric adenoma after EMR.
Subject(s)
Humans , Adenoma , Atrophy , Follow-Up Studies , Metaplasia , Mucous Membrane , Recurrence , Retrospective Studies , Stomach NeoplasmsABSTRACT
BACKGROUND/AIMS: The aim of this study was to investigate the immunohistochemical expression of bcl-2, bcl-xL, bax, and p53 proteins according to the pathological parameters such as grade of dysplasia, histological type, depth of invasion, lymph node metastasis, and TNM stage in the gastric adenoma and gastric adenocarcinoma. METHODS: Immunohistochemical staining using monoclonal bcl-2, bcl-xL, bax, p53 antibodies were performed on paraffin embedded specimens from forty-one gastric adenomas and 100 gastric adenocarcinomas. RESULTS: The expression rate of bcl-2 was higher in adenomas (34.2%), especially in high grade dysplasia (52.4%), than adenocarcinomas (2.0%). The expression rate of bcl-xL was higher in adenocarcinomas (55.0%) than adenomas (22%). The expression rate of the bax was higher in adenocarcinomas (58.0%) than adenomas (14.6%). In the adenocarcinoma, the bax expression was significantly related with the depth of invasion, lymph node metastasis, and TNM stage. The expression rate of p53 was higher in adenocarcinomas (64.0%) than adenomas (14.6%). CONCLUSIONS: Bcl-2 protein would be related with the development of gastric adenoma, especially with high grade dysplasia. Bcl-xL and p53 proteins would be involved in the development of relatively early stage of gastric adenocarcinoma but not in tumor progression. Bax protein would be involved in the development of gastric adenocarcinoma and related with depth of invasion, lymph node metastasis, and TNM stage.
Subject(s)
Female , Humans , Male , Middle Aged , Adenocarcinoma/metabolism , Adenoma/metabolism , Immunohistochemistry , Proto-Oncogene Proteins c-bcl-2/metabolism , Stomach Neoplasms/metabolism , Tumor Suppressor Protein p53/metabolism , bcl-2-Associated X Protein/metabolism , bcl-X Protein/metabolismABSTRACT
BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) is frequently performed for the treatment of gastric adenoma or early gastric cancer. These lesions are commonly associated with atrophic gastritis and synchronous lesions are not uncommon. The aim of this study was to evaluate the usefulness of chromoendoscopy with indigocarmine in detecting additional lesions patients referred for EMR. METHODS: Chromoendoscopy was performed in 51 patients (M : F=41 : 10, mean age= 60 year). After a careful examination, the stomach was stained with a 30 mL of indigocarmine (0.2%) with a spraying catheter. The changes in size of the lesions and the possibility of finding additional lesions were compared between before and after spraying dye. RESULTS: Before dye-spraying, six additional lesions were found. On the other hand, before the chromoendoscopy with indigocarmine. And among these, microscopic examination confirmed the presence of adenomas for additional three lesions. After spraying indigocarmine, eight additional lesions were found suspicious for adenoma, after the dye spraying. However, there was no neoplastic lesions histopathologically. With dye-spraying, the lesions looked bigger in four cases. And the three lesions among them showed similar size compared to the patholgic report. CONCLUSIONS: A conventional gastroscopic examination was enough to find additional adenoma or cancer, whereas chromoendoscopy was not so helpful in detecting additional lesions. In addition, because indigocarmine dye-spraying could outline mucosal elevations, chromoendoscopy was benefical in accurately measuring the size of the lesion.