Endoscopic PDD was performed 3 h after the oral administration of 20 mg/kg 5-ALA. For the in vivo fluorescence detection of PpIX accumulation, a Sie-P1video image endoscope system (Fuji Film Medical Co., Tokyo, Japan) consisting of a VP-0001 processor, an LL-4450-P1 light source, and an XG-0002-P1 scope or a Sie-P2 system (Fuji Film Medical Co.) with a VP-7000-P2 processor, an LL-7000-P2 light source, and an EG-L590ZW esophagogastroduodenoscopy scope was used (12 (link), 13 (link)). A 410-nm laser was used for blue-light excitation of PpIX to induce red fluorescence emittance. When a fluorescence signal was visualized and confined to the tumor and not in the surrounding non-tumorous tissue, it was referred to as PDD-positive. After identifying the lesion, the stomach cavity was evaluated followed by endoscopic submucosal dissection (ESD) of the target lesion(s). Thus, endoscopic PDD was performed on the day of ESD immediately prior to performing the ESD procedure. Whereas ESD was performed for lesions with a nominal risk of lymph node metastasis, in accordance with previously described criteria (14 (link)), five patients underwent standard surgery with the removal of regional lymph nodes. All patients were shielded from strong light, such as direct sunlight, for 24 h following the 5-ALA PDD procedure to avoid potential phototoxic reactions.
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