Gastric Cancer

, Volume 21, Issue 6, pp 998–1003 | Cite as

Gastric washing by distilled water can reduce free gastric cancer cells exfoliated into the stomach lumen

  • Atsuko OhkiEmail author
  • Nobutsugu Abe
  • Eri Yoshimoto
  • Yoshikazu Hashimoto
  • Hirohisa Takeuchi
  • Gen Nagao
  • Tadahiko Masaki
  • Toshiyuki Mori
  • Yasuo Ohkura
  • Masanori Sugiyama
Original Article



Intragastric free cancer cells in patients with gastric cancer have rarely been studied. The purpose of this study was to investigate the detection rate of intragastric free cancer cells in gastric washes using two types of solutions during endoscopic examination. We further clarified risk factors affecting the presence of exfoliated free cancer cells.


A total of 175 patients with gastric cancer were enrolled. Lactated Ringer’s solution (N = 89) or distilled water (DW; N = 86) via endoscopic working channel was sprayed onto the tumor surface, and the resultant fluid was collected for cytological examination. We compared the cancer-cell positivity rate between the two (Ringer and DW) groups. We also tested the correlation between cancer-cell positivity and clinicopathological factors in the Ringer group to identify risk factors for the presence of exfoliated cancer cells.


The cancer-cell positivity rate was significantly higher in the Ringer group than that in the DW group (58 vs 6%). Cytomorphology in the Ringer group was well maintained, but not in the DW group. The larger tumor size (≥ 20 mm) and positive lymphatic involvement were significant risk factors of exfoliated free cancer cells.


Cancer cells can be highly exfoliated from the tumor surface into the gastric lumen by endoscopic irrigation in large gastric cancer with lymphatic involvement. Gastric washing by DW can lead to cytoclasis of free cancer cells; therefore, it may minimize the possibility of cancer-cell seeding in procedures carrying potential risks of tumor-cell seeding upon transluminal communication, such as endoscopic full-thickness resection and laparoscopy–endoscopy cooperative surgery.


Gastric cancer Exfoliated free cancer cells Gastric washing cytology Distilled water 



The authors would like to thank Ms. Michiru Umino and Ms. Kazumi Ohshima of Kyorin University for excellent help with the cytology of samples.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study was obtained from all patients.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Atsuko Ohki
    • 1
    Email author
  • Nobutsugu Abe
    • 1
  • Eri Yoshimoto
    • 1
  • Yoshikazu Hashimoto
    • 1
  • Hirohisa Takeuchi
    • 1
  • Gen Nagao
    • 1
  • Tadahiko Masaki
    • 1
  • Toshiyuki Mori
    • 1
  • Yasuo Ohkura
    • 2
  • Masanori Sugiyama
    • 1
  1. 1.Department of SurgeryKyorin University School of MedicineTokyoJapan
  2. 2.Pathology and Cytology Center, PCL JAPANSaitamaJapan

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