Endoscopic submucosal dissection for early gastric cancer using endoscopy with Fuji Intelligent Color Enhancement.

Demarcation of early gastric cancers is sometimes unclear. Indigo carmine chromoendoscopy has usually been used as a diagnostic method for tumor margins as it enhances mucosal irregularities and differences in color. Fuji Intelligent Color Enhancement (FICE), a recently developed virtual chromoendoscopic system, can explore the entire mucosal surface (of structures and vessels). Here we report a case of a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) using endoscopy with FICE. A 58-year-old man with early gastric cancer underwent an ESD. Demarcation of the lesion was not clear through normal endoscopy. Therefore, an endoscopy was performed with FICE, which clearly revealed the demarcation. An ESD was carried out after spots were marked circumferentially. We identified the positional relationship between the demarcation and all markings on the magnifying model. A resection of the lesion was performed on the area outside the markings. Finally, the lesion was Histopathologically diagnosed as a well-differentiated adeno-carcinoma confined in the mucosal region, and the margins were free from carcinoma. FICE, especially combined with the magnifying model, is useful in the identification of the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.