Lugol ( chromoendoscopy )

Transcription

1 Lugol ( chromoendoscopy ) ( squamous cell carcinoma, SCC ) ( EUS,PET, EOCT ) Lugol chromoendoscopy ( ) ( endoscopic ultrasound EUS ) ( endoscopic mucosal resection EMR ) ( Iodine ) Lugol ( Lugol chromoendoscopy ) ( Esophageal cancer ) ( topographic stain ) indigo carmine ( chromoendoscopy ) ( mucosa ) 1 (absorptive stain) ( methylene blue ) ( squamous cell carcinoma, SCC ) 1-3% Lugol chromoendoscopy ( ) Lugol's 333 5

2 Lugol 163 Endoscopic stains Lugol's iodine solution 2.Barrett's 2. ( ablation ) intestinal metaplasia Toluidine blue ( nucleic acid ) Methylene blue 1. intestinal metaplasia gastric metaplasia 2. 3.Barrett's (intestina metaplasia) 3. Indigo carmine India ink (carbon) (intramural or submu- 3. cosal) Congo red ph < solution achalasia ( endoscopic ultrasound EUS ) ( endoscopic mucosal resection EMR ) Lugol JGA Lugol ( ) ( iodine ) ( KI ) 1~3% 85% prickle cell layer ( 90%) m stratum corneum stratum granulosum stratum spinosum stratum basale stratum spinosum prickle cell layer ( glycogen ) Lugol Chromoendoscopy ( mucolytic agent ) acetylecysteine 10-20ml

3 164 solution (a) (b) Lugol's (hematoxylin and eosin X 200) 3 9 staining stratum spinosum cm dye-spraying EUS 1993 Mori 2 (hyperpigmentation) atypia carcinoma 2001 Inoue 60% tiger-spot-like stain- 3 ing angiogenesis 2002 Muto Lugol-Voiding lesions ( LVLs ) 4 Group A LVLs B ( 10 ) LVLs ( 5mm ) C ( 10 ) LVLs D ( 10 ) multiform LVLs Group C D 24.2% 54.8% SCC

4 Lugol 165 Thuler Lugol chromoendoscopy (chemical esophagitis) Sreedharan (STS) 2Na2S2O3 ( acute toxic gastric mucosal damage ) 6 7 sodium thiosulfate STS cyanide iodine arsenic STS I 2 + 2NaI +Na2S4O Schiller 1966 Voegeli Schiller test ( margin ) 1972 Endo SCC Nabeya % 100% 75% 100% Kuwano Sugimachi 156 severe Miyamoto % 71.4% ( 10.3% ) CCRT Nishizawa X Kyushu Sugimachi % 20% Takechi 2 50 Lugol's staining 10 achalasia 1995 Yokoyama ( 25.8% ) 21 ( 3.3% ) ( superficial type ) Freitag occult 80% ( sensitivity ) 63% ( specificity ) negative predictive value 98% positive predictive value 12.5% Ina

5 % Fukuzawa Tincani Loviscek achalasia 10 Lugol-negative 4 achalasia Yamamura achalasia Lugol chromoendoscopy Kumagai 2004 methylene blue ( endocytoscopy system ) Olympus endoscopic optical coherence tomography ( EOCT ) ( Barrett'S ) mm EUS Pentax ( confocal laser microscopy ) 2004 Ralf Kiesslich confocal endoscopy ( intraepithelial neoplasia ) 99.2% Koyanagi telomerase telomeric repeats ( TTAGGG ) n Confocal endoscopy ) ( EUS, PET, EOCT, ( germline ) iodine nonreactive carcinoma in situ dysplasic cells carcinogenesis Indigo carmine methylene blue ( magnifying endoscopy ) 1.Acosta MM, Boyce HW. Chromoendoscopy-where is it useful? J Clin Gastroenterol 1998; 27: Mori M, Adachi Y, Matsushima T, Matsuda H, Kuwano H, Sugimachi K. Lugol staining pattern and histology of esophageal lesions. Am J Gastroenterol 1993; 85: Inoue H, Rey JF, Lightdale C. Lugol chromoendoscopy for esophageal squamous cell cancer. Endoscopy 2001; 33: Muto M, Hironaka S, Nakane M, Boku N, Ohtsu A, Yoshida S. Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in pa-

6 Lugol 167 tients with head and neck cancer. Gastrointest Endosc 2002; 56: Thuler FP, de Paulo GA, Ferrari AP. Chemical esophagitis after chromoendoscopy with for esophageal cancer: case report. Gastrointest Endosc 2004; 59: Sreedharan A, Rembacken BJ, Rotimi O. Acute toxic gastric mucosal damage induced by Lugol's iodine spray during chromoendoscopy. Gut 2005; 54: Kondo H, Fukuda H, Ono H, et al. Sodium thiosulfate solution spray for relief of irritation caused by Lugol's stain in chromoendoscopy. Gastrointest Endosc 2001; 53: Nishizawa M, Yamaki G, Nomoto K, et al. Early detection of esophageal cancers, with special reference to the intraepithelial stage. Japanese J Cancer Clinics 1984; 30: Sugimachi K, Ohno S, Matsuda H, Mori M, Kuwano H. Lugolcombined endoscopic detection of minute malignant lesions of the thoracic esophagus. Ann Surg 1988; 208: Takechi K, Shiroko J, Tomita E, et al. Two cases of endoscopically identified esophageal cancer of the superficial-slightly depressed type. Endoscopy 1991; 23: Nabeya K, Hanaoka T, Onozawa K, Ri S, Nyumura T, Kaku C. Early diagnosis of esophageal cancer. Hepato-gastroenterol 1990; 37: Kuwano H, Kitamura K, Baba K, et al. Determination of the resection line in early esophageal cancer using intraoperative endoscopic examination with Lugol staining. J Surg Oncol 1992; 50: Sugimachi K, Kitamura K, Baba K, Ikebe M, Kuwano H. Endoscopic diagnosis of early carcinoma of the esophagus using. Gastrointest Endosc 1992; 38: Miyamoto H, Adachi W, Koike S, Koide N, Iida F. Lugol staining for esophageal carcinoma and influence of radiotherapy. Japanese J Gastroenterol 1993; 90: Yokoyama A, Ohmori T, Makuuchi H, et al. Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining. Cancer 1995; 76: Freitag CP, Barros SG, Kruel CD, et al. Esophageal s are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil. Dis Esophagus 1999; 12: Ina H, Shibuya H, Ohashi I, Kitagawa M. The frequency of a concomitant early esophageal cancer in male patients with oral and oropharyngeal cancer. Screening results using Lugol dye endoscopy. Cancer 1994; 73: Fukuzawa K, Noguchi Y, Yoshikawa T, et al. High incidence of synchronous cancer of the oral cavity and the upper gastrointestinal tract. Cancer Letters 1999; 144: Tincani AJ, Brandalise N, Altemani A, et al. Diagnosis of superficial esophageal cancer and using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer. Head Neck 2000; 22: Yamamuro EM, Cecconello I, Iriya K, Tomishigue T, Oliveira MA, Pinotti HW. Lugol dye endoscopy for analysis of esophageal mucosa in achalasia. Hepato-gastroenterol 1999; 46: Koyanagi K, Ozawa S, Ando N, et al. Telomerase activity as an indicator of malignant potential in iodine-nonreactive lesions of the esophagus. Cancer 2000; 88: Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endocytoscopy system. Endoscopy 2004; 367: Kiesslich R, Burg J, Vieth M, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127:

7 168 Application of Lugol Chromoendoscopy on the Diagnosis of Early Esophageal Cancer Te-Sheng Chang, Chun-Jung Lin 1, and Wen-Shih Huang 2 Division of Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 1 Division of Gastroenterology, Department of Internal Medicine, Chang Gung Medical Center, Taoyan, Taiwan 2 Graduate Institute of Clinical Medicine, Chang Gung University, Taoyan, Taiwan Conventional esophago gastro duodenoscopy can disclose a lesion only when it presents as a protuberant mass, an ulceration or when there is significant discoloration. When an early esophageal squamous cell carcinoma or, frequently lacking such changes, is confronted, conventional endoscopy usually fails to detect it. Combination of endoscopy and mucosal staining, known as chromoendoscopy, deserves to be praised in the detection of early lesions aforementioned. Since the initial report of on the diagnosis of esophageal cancer 30 years ago, more and more publications have agreed with its usefulness as an assistant tool in the diagnosis of early esophageal cancer. Examples of its benefits include improving surgical decision making, better screening of high risk patients and facilitating endoscopic mucosal resection. With the growing popularity of much more expensive modalities such as EUS, PET, EOCT and molecular genetic technology; this convenient and non-expensive technique is worth practicing by endoscopist. ( J Intern Med Taiwan 2005; 16: )