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Endoscopic lymphography 1



Endoscopic lymphography 1



Gastroenterological Endoscopy 26(12): 2388-2396



In roentogenologic and endoscopic techniques, detection of digestive tract malignancies was not a difficult problem. Diagnosis of metastatic lymph nodes in patients with these conditions can only be achieved on pathological assessments at the time of operation or autopsy. The peri-gastric lymphatics were demonstrated on X-ray in gastric cancer patients with the newly developed endoscopic lymphography (ELG). The procedure is an indirect method using endoscopy, in which the contrast medium was given by the injector under endoscopic visualization into the sub-mucosa or muscle layer of the surrounding area of gastric lesion. The regional lymphatic vessels, the fine and afferant ducts, were clearly observed on X-ray immediately after the injection. The nodes were seen on X-ray after an interval between a few hours and 24 h later. The peri-gastric lymphatics were detected on ELG in 2 of 4 cases with early gastric cancer and in 8 of 10 cases with advanced cancer. In comparison to pathological diagnosis, non-metastatic lymph nodes revealed were < 5 mm in size, and these usually showed fine nodular patterns. Metastatic ones demonstrated filling defects, swelling, marginal irregularity and other abnormalities. The ELG may be a good indicator for the local treatment of early gastric cancer and for complete regional lymph node dissection at the operation. A further improvement in the techniques, X-ray demonstration and contrast medium is necessary for constant visualization of the lymphatics.

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