Endoscopic resection of early gastric cancer

Abstract

Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without metastases. Existing endoscopic mucosal resec-tion (EMR) is easy to perform, has few complications, and can be ap-plied when the lesion size is small. However, <i>en bloc</i> and complete re-section rates vary depending on the size and severity of the lesion. EMR using the cap-mounted panendoscopic method and EMR after circum-ferential preamputation of the lesion are useful in the treatment of EGC. However, completely oversized lesions (≥2 cm) and lesions associated with ulcers or submucosal fibrosis are more likely to fail resection. En-doscopic submucosal dissection has been widely used to resect tu-mors larger than 2 cm in diameter and has a higher acceptable compli-cation rate and <i>en bloc</i> and complete resection rates than EMR. ER for EGC is superior to surgical resection in terms of improving patient quali-ty of life. Additionally, compared to surgery, emergency rooms have a lower rate of treatment-related complications, shorter hospital stays, and lower costs. Accordingly, the indications for ER are expanding in the field of therapeutic endoscopy. Long-term outcomes regarding re-currence are excellent in both absolute and extended criteria for ER in EGC. Close surveillance should be performed after ER to detect early metachronous gastric cancer and precancerous lesions that can be treated with ER. Follow-up gastroscopy and abdominopelvic computed tomography scans every 6 to 12 months are recommended for patients who undergo curative ER for EGC on absolute or extended criteria.