Abstract
We read with great interest the article by Filippo Catalano and colleagues regarding early gastric cancer management [1].We appreciate the authors’ efforts to manage their series using a unique minimal access approach. The results were encouraging, especially for the management of cardia lesions, which are technically challenging. However, we have some points that we consider complementary to the educational value of the study. First, the curative resection was 56% in the endoscopic mucosal resection (EMR) group compared with 92% in the endoscopic submucosal dissection (ESD) group. The authors allowed a 5-mm safe margin for their resections. If a 1-cm margin is used, the percentage of curative resection could be better. Second, we find it important to know the results of preoperative investigations (e.g., endoscopic ultrasound) to determine which patients are to be included in the study. Finally, in about 50% of the cases, the tumor size was 5–10 mm. Such sizes can be missed during routine gastroscopy, and we question whether indigo carmine should be used for all high-risk patients instead of the patients who would need ESD [2]. We appreciate a kind response from the authors.
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