Endoscopy 2002; 34(5): 369-375
DOI: 10.1055/s-2002-25285
Original Article

© Georg Thieme Verlag Stuttgart · New York

Magnifying Endoscopy, Stereoscopic Microscopy, and the Microvascular Architecture of Superficial Esophageal Carcinoma

Y.  Kumagai 1 , H.  Inoue 1 , K.  Nagai 1 , T.  Kawano 1 , T.  Iwai 1
  • 1 First Department of Surgery, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
Weitere Informationen


29 March 2001

1 December 2001

22. April 2002 (online)

Background and Study Aims: In this study we clarify the microvascular architecture of superficial esophageal carcinoma as observed by ultra-high magnification endoscopy and stereoscopic microscopy with Microfil injection.
Patients and Methods: We observed two surgically resected specimens of superficial esophageal cancer under stereoscopic microscopy with Microfil injection. In addition, in the histological investigation, we measured the caliber of the vessels at the surface of the tumor. We carried out ultra-high magnification before treatment in 82 patients with superficial esophageal neoplasms. We classified the depth of tumor penetration of superficial esophageal carcinoma into four categories: m1 to m3 (mucosal cancer) and sm (submucosal cancer).
Results: By observing the normal esophageal mucosa under a stereoscopic microscope and an ultra-high magnification endoscope, we were able to visualize the intrapapillary capillary loops (IPCL). In cancer lesions, we observed characteristic changes in the superficial microvascular architecture according to the depth of tumor invasion. In m1 invasion, there was dilatation of the IPCL; in m2 invasion, there was dilatation and elongation of the IPCL; in m3, there was a mixed appearance of the IPCL and tumor vessels; and in sm invasion, complete replacement by tumor vessels. On the basis of the above criteria, ultra-high magnification endoscopic observation before treatment showed a rate of agreement between histological depth of invasion and magnified appearance of 60/72 cases (83.3 %) for which satisfactory pictures were obtained. The histological investigation showed the caliber of the IPCL of the m1 cancer lesions (12.9 ± 3.9 µm) to be significantly greater than that of the normal esophageal mucosa (6.9 ± 1.5 µm) (P < 0.0001).
Conclusions: Observation of the microvascular architecture of superficial esophageal carcinoma is useful in the diagnosis of the depth of invasion.


  • 1 Okuyama Y, Takemoto T, Tsuneoka K. et al . Specially designed gastroscope for magnified observation [in Japanese].  Gastroenterol Endosc. 1967;  9 42-43
  • 2 Honda T, Takeshita K, Tani M. et al . Diagnosis of gastric elevated lesions using magnifying electronic endoscopy and ”band enhancement“ [in Japanese with English abstract].  Progr Dig Endosc. 1994;  44 68-72
  • 3 Tada M, Nishimura S, Watanabe Y. et al . Anew method for the ultra-magnifying observation of the colon mucosa.  J Kyoto Pref Univ Med. 1982;  91 349-354
  • 4 Makuuchi H, Machimura T, Sou Y. et al . Examination of esophageal superficial cancer by magnifying endoscopy [in Japanese with English abstract].  Endosc Dig. 1991;  3 412-421
  • 5 Inoue H, Honda T, Yoshida T. et al . Ultra-high magnification endoscopy of the normal esophageal mucosa.  Dig Endosc. 1996;  2 134-138
  • 6 Inoue H, Honda T, Nagai K. et al . Ultra-high magnification endoscopic observation of carcinoma in situ.  Dig Endosc. 1997;  1 16-18
  • 7 Ohkura Y, Nishizawa M, Hosoi T. Esophageal mucosal cancer: classification and the depth of invasion from the pathological point of view [in Japanese with English abstract].  I to Cho (Stomach Intestine). 1994;  29 263-271
  • 8 Endo M, Kawano T. Detection and classification of early squamous cell esophageal cancer.  Dis Esoph. 1997;  10 155-158
  • 9 Inoue H, Takeshita K, Hori H. et al . Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions.  Gastrointest Endosc. 1993;  39 58-62
  • 10 Kawano T, Endo M. A new multipurpose tube for esophageal endoscopy.  Endoscopy. 1997;  29 S26-S27
  • 11 Kuwano H, Sonoda K, Yasuda M. et al . Tumor invasion and angiogenesis in early esophageal squamous cell carcinoma.  J Surg Oncol. 1997;  65 188-193
  • 12 Aharinejad S, Lametschwandtner A, Franz P. et al . The vascularization of the digestive tract studied by scanning electron microscopy with special emphasis on the teeth, esophagus, stomach, small and large intestine, pancreas, and liver.  Scanning Microsc. 1991;  5 811-849
  • 13 Weinder N, Folkman J, Pozza F. et al . Tumor angiogenesis: a new significant and independent prognostic indicator in early-stage breast carcinoma.  J Natl Cancer Inst. 1992;  84 1875-1887
  • 14 Porschen R, Classen S, Piontek M. et al . Vascularization of carcinomas of the esophagus and its correlation with tumor proliferation.  Cancer Res. 1994;  54 587-591
  • 15 Sariba M, Bittinger F, Porschen R. et al . Tumor vascularization and prognosis in squamous cell carcinomas of the esophagus.  Anticancer Res. 1996;  16 2117-2122

Y. Kumagai, M.D.

First Department of Surgery · Tokyo Medical and Dental University School of Medicine

Yushima 1-5-45 · Bunkyo-ku · Tokyo 113-8519 · Japan

Fax: + 81-3-38174126 ·

eMail: kuma.srg-k@komagome-hospital.bunkyo.tokyo.jp