| Theme | The Guidelines of ESD/EMR for Early Gastric Cancer | |
|---|---|---|
| Title | Explanation of Guidelines for ESD and EMR for Early Gastric Cancer : Evaluation of Diagnostic Criteria and Curative Excision | |
| Publish Date | 2015/06 | |
| Author | Daisuke Yamaguchi | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Mitsuhiro Fujishiro | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo / Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo |
| Author | Yosuke Tsuji | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Shuntaro Yoshida | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Kazuma Fujimoto | Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School |
| Author | Kazuhiko Koike | Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo |
| [ Summary ] | Early detection and early treatment are vital, as these improve the prognosis of patients with gastric cancer. The most important indications for endoscopic treatment of early gastric cancer are determined by considering the risk of lymph node (LN) metastasis and technical problems and by considering whether to resect the tumor en bloc. The absolute criteria for endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) are papillary or tubular (differentiated) adenocarcinoma, less than 2 cm in diameter, and without ulceration within the tumor. The extended criteria for ESD/EMR are therefore : 1) no size limitation for intramucosal differentiated cancers without ulceration ; 2) less than 3 cm in diameter for differentiated cancers with ulceration ; or 3) less than 2 cm in diameter for undifferentiated intramucosal cancers without ulceration. These lesions have no or minimal risk of LN metastasis. When curative excision is achieved for an indicated lesion, the risks of local recurrence and LN metastasis are extremely low. However, when the pathological examination indicates noncurative resection, additional surgery, including LN dissection, is strongly recommended. After having understood these guidelines correctly, the treatment strategy for patients with early gastric cancer should be determined on an individual basis, considering patient background and the tumor characteristics. |
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