Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review

As detection of early gastric cancer (EGC) has improved, endoscopic mucosal resection (EMR) has been adopted as a treatment option for small intramucosal carcinoma. Endoscopic submucosal dissection (ESD) has enabled high en bloc resection rate for small and large lesions, as well as those with scarring. Moreover, the specimens obtained by ESD facilitate precise histological assessment of curability compared with the piecemeal specimens obtained by EMR. Accordingly, ESD has been established as a standard treatment for management of EGC in Japan. The long-term outcome of endoscopic management of EGC is based on: a) the accuracy of endoscopic diagnosis which defines the optimal treatment; b) endoscopist’s expertise on methods for tumor removal (currently techniques of ESD); c) precise histological assessment of the resected specimen for curability; and d) surveillance endoscopy for early detection of metachronous multiple cancer. Efforts to establish a standardized protocol for practice and training can accelerate dissemination of gastric ESD in regions where gastric cancer is highly prevalent, and may help endoscopists worldwide to adopt this technique for other organs in the digestive tract.