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Background <p>Accurate diagnosis of the depth of invasion is critical in determining appropriate treatment in early gastric cancer (EGC), especially when submucosal deep invasion (d-SM) is suspected. The diagnostic accuracy of conventional endoscopic ultrasonography (EUS) remains limited; however, the use of large volumes of de-aerated water carries a risk of aspiration pneumonia.</p> Methods <p>This retrospective study evaluated the diagnostic performance and safety of gel-EUS, a method that uses a transparent, viscous gel instead of water. A total of 81 EGC lesions suspected of submucosal invasion were investigated: 52 underwent conventional EUS (group W) and 29 underwent gel-EUS (group G). The diagnostic sensitivity, specificity, safety outcomes, and examination time were compared between the two groups.</p> Results <p>Gel-EUS showed significantly higher sensitivity in detecting d-SM cancer compared to conventional EUS (83.3% vs. 25.0%), while its specificity was somewhat lower (70.6% vs. 89.7%). The examination time was significantly shorter in group G (median 3.0 vs. 8.0&#xa0;min, <i>p</i> &lt; 0.001). Aspiration events occurred less frequently in group G (3.7% vs. 13.4%). The single aspiration case in group G occurred before the gel infusion. Although midazolam use was higher in group G, there were no significant differences in oxygen use, saturation, or blood pressure.</p> Conclusions <p>Gel-EUS is a safe and efficient alternative to conventional EUS, offering higher sensitivity, shorter examination time, and reduced aspiration risk. This novel approach may improve the diagnostic accuracy for deep submucosal invasion in EGC and assist in optimal treatment selection.</p>

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Improved diagnostic accuracy and safety of gel-endoscopic ultrasonography for deep submucosal invasion in early gastric cancer

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Ai Fujimoto,
  • Junji Tanaka,
  • Nobuyuki Sato,
  • Kenzo Hara,
  • Keita Suzuki,
  • Hikari Kobayashi,
  • Yusuke Nishikawa,
  • Masashi Ono,
  • Kazuhisa Yamaguchi,
  • Takahito Toba,
  • Takahisa Matsuda

摘要

Background

Accurate diagnosis of the depth of invasion is critical in determining appropriate treatment in early gastric cancer (EGC), especially when submucosal deep invasion (d-SM) is suspected. The diagnostic accuracy of conventional endoscopic ultrasonography (EUS) remains limited; however, the use of large volumes of de-aerated water carries a risk of aspiration pneumonia.

Methods

This retrospective study evaluated the diagnostic performance and safety of gel-EUS, a method that uses a transparent, viscous gel instead of water. A total of 81 EGC lesions suspected of submucosal invasion were investigated: 52 underwent conventional EUS (group W) and 29 underwent gel-EUS (group G). The diagnostic sensitivity, specificity, safety outcomes, and examination time were compared between the two groups.

Results

Gel-EUS showed significantly higher sensitivity in detecting d-SM cancer compared to conventional EUS (83.3% vs. 25.0%), while its specificity was somewhat lower (70.6% vs. 89.7%). The examination time was significantly shorter in group G (median 3.0 vs. 8.0 min, p < 0.001). Aspiration events occurred less frequently in group G (3.7% vs. 13.4%). The single aspiration case in group G occurred before the gel infusion. Although midazolam use was higher in group G, there were no significant differences in oxygen use, saturation, or blood pressure.

Conclusions

Gel-EUS is a safe and efficient alternative to conventional EUS, offering higher sensitivity, shorter examination time, and reduced aspiration risk. This novel approach may improve the diagnostic accuracy for deep submucosal invasion in EGC and assist in optimal treatment selection.