| Gastroesophageal junction cancer is one of the common gastrointestinal tumors. Currently, the incidence rate has increased around the world. In contrast, the incidence rate of esophageal squamous cell carcinoma and adenocarcinoma of the distal stomach have decreasedin the past 10 years.Whenpatients with Siewert Ⅲtype of gastroesophageal junction cancer showclinical symptoms, the cancerhaveprogressed.Even the patientsundergoing surgery, the 5-year survival rate islower than the distal gastric cancersignificantly. Progressed gastroesophageal junction cancershave poor effect, spend more money to cure, but the 5-year survival rate is low.The 5-year survival rate of the early gastroesophageal junction cancercanraiseup to 90%. If we detect the gastroesophageal junction cancer early and give curetimely and effectively,the patients willhave better result. Because the gastroesophageal junction is a special site, the atypical performanceis often missedunder the endoscopy. Althoughthe early gastroesophageal junction cancerhas been focused in recent years,clinical studies have few reports. We must understandthe features ofthe early gastroesophageal junction cancer under the endoscopy and apply in clinical endoscopy procedures, thenwe can find the early gastroesophageal junction canceraccurately.Objective The aim of this study was to evaluate the diagnosis performance of the ordinary white light endoscopy(WLE) and magnification endoscopy with narrow band imaging( ME-NBI)in early gastroesophageal junctional(GEJ) cancer.Methods This study retrospectively analyzed 53 cases which were endoscopically and histologically diagnosed as early GEJ cancer in the gastrointestinal endoscopy center of The Second Affiliated Hospital of Zhengzhou University and The 152 hospital of The PLA from Nov. 2011 to Jul 2015. The lesions characteristic, the features of white light and ME-NBI images and the clinicopathological features were analyzed by χ2 test.Results 67.9%(36/53) of the early GEJ cancer were classified as Siewert type Ⅱ, and 58.3%(21/36) of which were found in the posterior wall below cardiac region(P=0.028). The main endoscopic type were Type0-II(94.3%, 50/53), and the Siewert type Ⅱ lesions were also showed Type0-II(97.2%, 35/36). We need to reverse the lens barrel to view the whole pictures of Type0-II lesions, and a small number of lesions viewed to be accompanied by a positive lens. The lesion mucosa showed flushing(90.6%, 48/53), rough(79.2%, 42/53), erosion(35.8%, 19/53) under the ordinary white light endoscopy. The submucosal microvascular patterns were irregular or disappeared in 96.7%(29/30), the epithelial fine structure and pit patterns were irregular or disappeared in 90%(27/30). And the lesions boundaries were clear in 86.7%(26/30) under the NBI. The Barrett?s esophagus with Siewert type Ⅰ, Ⅱ and Ⅲ accounted for 83.3%(5/6), 11.1%(4/36) and 9.1%(1/11) respectively(type Ⅰ versus Ⅱ,P= 0.001; type Ⅱ versus Ⅲ, P= 0.011; type Ⅰ versus Ⅲ,P=1.000). The ratio of the intestinal metaplasia with Siewert type Ⅰ, Ⅱ and Ⅲ lesions were 16.7%(1/6), 75.0%(27/36) and 63.6%(7/11) respectively(type Ⅰ versus Ⅱ,P = 0.019; type Ⅰ versus Ⅲ,P = 0.178; type Ⅱ versus Ⅲ, P= 0.725).Conclusions The Siewert type Ⅱ early cancer is more common among cancer. Most of theearly GEJ cancer lesions are shown the Type 0-II lesions and located in the posterior wall below cardiac region. The mucosal lesions appear flushing, rough, erosion under WLE. The submucosal microvascular, epithelial fine structure and pit patterns appear irregular or disappeared, and clear lesions boundaries under ME-NBI. Siewert type Ⅰ tends to complicated with barrett’s esophagus, and Siewert type Ⅱ and Ⅲ tend to complicated with intestinal metaplasia. |
