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Gastric Cancer pp 149-160 | Cite as

Endoscopic Treatment

  • Takuji Gotoda
Chapter

Abstract

In the past, gastrectomy with lymph node dissection was the gold standard treatment for all patients with operable gastric cancer including early cancer. It has been well known that the incidence of lymph node metastasis from early gastric cancer is not so high. If the group with very low risk of lymph node metastasis is identified, cure can be accomplished by endoscopic resection as local control.

EMR techniques could not be used to remove lesions en bloc larger than 2 cm. Piecemeal resections in lesions larger than 2 cm lead to a high risk for local cancer recurrence and inadequate pathological staging. Thus, the indication for endoscopic resection has been very strict. ESD which can allow en bloc resection regardless of the tumor size is now standard option. From revised Gastric Cancer Treatment Guideline, the case now classified into expanded criteria is modified as absolute criteria, if the lesion is removed by ESD.

When the tumor does not meet several pathological factors, the resection is finally valued as “non-curative” resection, then recommended to undergo surgery. However, only 5–10% lymph node metastasis is found in patients who underwent surgery. Recently, a simple scoring system called as “eCura system” for decision-making in patients with non-curative ESD has been established using large-scale retrospective study. This scoring system predicted cancer-specific survival in patients who did not meet the curative criteria. ESD without additional treatment may be an acceptable option for patients at low risk, especially elderly patients.

In the medical care, the duty of medical professionals should be to alleviate the concern of patients as much as possible by providing them with detailed information on postoperative outcomes and potential risks estimated based on outcome assessment. Moreover, medical professionals must continuously consider whether complete treatment attempted by physicians is beneficial for patients and whether treatment that is not the best but more tolerable to the patients is an option.

Keywords

Early gastric cancer Japanese Gastric Cancer Treatment Guideline eCura system Endoscopic submucosal dissection Clutch Cutter 

Abbreviation

DFC

Dental floss and a hemoclip

EGC

Early gastric cancer

EMR

Endoscopic mucosal resection

EMRC

EMR with cap-fitted panendoscope method

EMRL

EMR using multiband ligation

ESD

Endoscopic submucosal dissection

IT knife

Insulated-tip diathermic knife

LNM

Lymph node metastasis

QOL

Quality of life

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Takuji Gotoda
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineNihon University School of MedicineTokyoJapan

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