ENDOSCOPIC EVALUATION OF GASTRIC-CANCER INFILTRATING THE LOWER ESOPHAGUS

Endoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergon e gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically b roken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal inf iltration. Endoscopy used for histological evaluation frequently revea led the protruded type to be whole layer and had a highly accurate dia gnosis rate (94%); it revealed the histology of the other four types t o be primarily superficial. Extent of cancer invasion was underestimat ed in giant-rugae tumors (40%), as endoscopy could barely detect the s mall nest of esophageal infiltrations. Lugol staining was useful in pr eventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen sec tion taken from the proximal edge of resected specimen.