1. EISD for Cardiac lesion
소화기내시경 집담회
EISD for Cardiac lesion
YS Kim, JY Cho, SY Jin*,
IS Jung, CB Ryu, MS Lee, CS Shim.
Digestive Disease Center and *Pathology,
SoonChunHyang University College of Medicine.

2. 김O희, 66/F
Chief complaint: Indigestion
Referred from other hospital
Past MHx: Hypertension(+), Diabetes melitus(+)
Impression: EGC IIa

3. Cardia, PW, Type IIa
Gastrofiberscopic biopsy : Adenoma with high grade dysplasia

5. EISD

6. Specimen after EISD The specimen pinned on card board
A more detailed examination by using stereomicroscopy

7. Adenocarcinoma, well differentiated, confined to the mucosa
Pathology
H & E stain
X 40
X 100
Adenocarcinoma, well differentiated, confined to the mucosa

8. Immunohistochemistry stain
MUC 1 (+)
MUC 2 (-)
lyOvO
MUC1(+)
MUC2(±)
F-VIII(-)
D2-40(-)

10. Resected Specimen + Well differentiated Low grade atypia
Adenocarcinoma
Well differentiated
Low grade atypia
Dominant gastric type M2
3.2 cm x 1.7 cm
Slice 20 - Lat(+)
Vertical(-)
LyOVO 20 1 +

11. Burning Effect
(+)
(+)
(+)
2mm
(+)
(+)
(+)
Complete resection
1 point positive
2 point positive
3 point positive
Incomplete resection
Margin positive N
Burning effect
Recurrence 1 59
100% 0% 2 39
64%
36% 3 10
10%
90% 4 11 ?
CIH

12. Follow-up
1 week after EISD
6 weeks after EISD (pre-bougie dilatation)

13. Bougie dilatation Savary guidewire - 16mm까지 dilatation
- 6weeks after EISD
Savary guidewire mm까지 dilatation
- 7 weeks after EISD

14. Follow-up
10 weeks after EISD

15. In summary Post EISD stricture on cardia and EGJ of EGC
Bougie dilatation of post EISD stricture
Burning effect on resected margin

17. Incorrect !

18. How far dissect sm layer ? Cuttoff value: 500 μm ?
Gastric antrum of pig
Same size specimen of pig stomach, antrum
2 cm
2.5 cm
3 cm
Stretched fully mm mm mm sm
200μm
500μm sm
250μm sm pm pm pm
Masson’s trichrome stain, ⅹ100
MT stain, ⅹ100
MT stain, ⅹ100

19. Gastric antrum of humanmm mm sm μm sm μm pm pm
Masson’s trichrome stain, ⅹ100
Masson’s trichrome stain, ⅹ100
2.5 x 1.0cm
3.0 x 1.7cm

20. Gastric body, GC of humanmm mm sm μm sm
300μm pm pm
Masson’s trichrome stain, ⅹ100
Masson’s trichrome stain, ⅹ100
2.5 x 0.8cm
3.0 x 1.7cm

21. Gastric body, LC of humanmm sm μm mm pm sm μm pm
Masson’s trichrome stain, ⅹ100
Masson’s trichrome stain, ⅹ100
2.5 x 1.3cm
3.2 x 1.7cm

22. Discussion In surgical specimen: sm1 cutoff value: 500 μm
2. In EMR specimen, stretched fully: cutoff value: ?
1) antrum: 192 μm 2) body, GC: 215 μm
3) body, LC: 389 μm
3. sm1 cutoff = 500 μm x constant (?)
# constant (?) = sm of non stretched specimen
(부위별) sm of fully stretched specimen

23. Thanks for your attention
Digestive Disease Center and Pathology,
Soon Chun Hyang University College of Medicine.