Enhanced Better Detection Of Gastric Cancers By Autofluorescence Endoscopy Coupled With The Noradrenaline Spraying Method (Pharmaco Life-Gi).

Background and Purpose: The light induced fluorescence endoscopy (LIFEGI: Zillix and Olympus) system has been reported to facilitate detection of cancers of gastrointestinal (GI) tract. However, the marginal image of tumors by LIFE-GI is sometimes unclear, due to fluorescence-influencing biological substance such as blood pigments, porphyrin and flavins. The pharmacoendoscopy, in which noradrenaline is sprayed onto tumors is reported to emphasize the tumor margin by the decreased blood flow in tumors and adjacent tissue. In order to enhance autofluorescent tumor image, we used pharmacoendoscopy simultaneously with LIFE-GI (pharmaco LIFE-GI). Patients and Methods: Subjects were 21 cases of gastric cancers, including 16 early and 5 advanced cancers. After a conventional endoscopic examination followed by the regular LIFE-GI observation, 20 ml of 0.02 % noradrenaline was sprayed onto the tumors and LIFE-GI images were obtained 5 minutes later. In order to evaluate the enhanced detectability of cancers, three examiners scored each case independently based on the enhancement of tumor margins; 0: no or minimal enhancement, +1: moderate enhancement, +2: marked enhancement. All cancers were observed as emitting dark red color under LIFE-GI against the background normal tissue emitting green color. Results: Regarding the scores of the tumors image enhancement, 4 of 21 cases were of +2 score, 12 cases of +1 score, and the rest of the cases (5 cases) of 0 score, indicating that 76.2 % of tumors was significantly enhanced by a pharmaco LIFE-GI. Conclusion:From the result of this study, marginal images of the tumors have been well enhanced by our new technique, a pharmaco LIFE-GI, which may be useful for better detection of gastric cancers.