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Abstract
Endoscopic mucosal resection (EMR) has been accepted as one of the standard treatments of early gastric cancer (EGC) with a negligible risk of lymph node metastasis. EMR is similar to surgery in efficacy but less invasive and more cost-effective. And it allows accurate histological staging of the tumor, which is critical in deciding whether additional treatment is necessary. Standard indications for EMR of EGC include differentiated elevated cancer less than 2 cm in size and depressed cancer without ulceration less than 1 cm in size. Recently, expanded indication has been proposed in Japan to cover other lesions with a negligible risk of lymph node metastasis, which include larger lesions and lesions with ulceration. With the development of endoscopic submucosal dissection (ESD), en bloc resection of larger and even ulcerative lesion is possible. However, the lack of long-term data makes it difficult to widely accept expanded indication. More long-term studies about therapeutic outcomes are needed to fully bolster the safety and establish correct therapeutic role of ESD in treatment of EGC.
Figures and Tables
Figure 1
Procedure of endoscopic submucosal dissection (ESD).
(A) Type IIa early gastric cancer located on anterior wall of gastric antrum, (B) marking outside the lesion, (C) Injection of diluted epinephrine mixed with methylene blue to raise the submucosa, (D) circumferential incision of the mucosa, (E) dissection of submucosal layer, (F) ulcer after resection of the lesion
Figure 2
Classic and Proposed Expanded Indications of Endoscopic Treatment for Early Gastric Cancer.
*Surgery is considered due to invasiveness of undifferentiated adenocarcinoma. However, some recommend inclusion to expanded indication due to negligible risk of lymph node metastasis (18). SM, submucosal invasion
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