Abstract
Gastric cancer is the most common cancer worldwide and it is often diagnosed in an advanced stage. In countries where screening endoscopy is performed widely, early detection is possible. In fact, early gastric cancer incidence is increasing during the last years worldwide and screening could be a major factor in such increase. In the past, the standard treatment of gastric cancer was surgical resection; however, the endoscopic treatment has increased due to advances in the instruments available and clinician experience. In fact, endoscopic resection has become one of the greatest advances in EGC treatment. It is the standard treatment in most of the cases because early gastric cancer is associated with a low rate of lymph node metastasis and a high survival rate. Endoscopic Mucosal Resection and more recently Endoscopic Submucosal Dissection are the two main developed procedures. Endoscopic Submucosal Dissection achieves a higher rate of en-bloc resection, complete resection, curative resection and lower local recurrence compared with Endoscopic Mucosal Resection group. The disadvantages associated with Endoscopic Submucosal Dissection, such as higher perforation rates and longer procedure time, will probably improve as the endoscopists experience increases and new endoscopic tools are developed. The aim of this paper is to review the management of EGC with a special focus on endoscopic detection, staging, therapy, surveillance, and prevention.
Highlights
Gastric cancer (EGC) is defined as a cancer that does not invade beyond the submucosa regardless of lymph node involvement
Endoscopic resection has become one of the greatest advances in Early gastric cancer (EGC) treatment. It is the standard treatment in most of the cases because early gastric cancer is associated with a low rate of lymph node metastasis and a high survival rate
Endoscopic Submucosal Dissection achieves a higher rate of en-bloc resection, complete resection, curative resection and lower local recurrence compared with Endoscopic Mucosal Resection group
Summary
Gastric cancer (EGC) is defined as a cancer that does not invade beyond the submucosa regardless of lymph node involvement. Over the past 20 years novel procedures for endoscopic resection have been developed. They include mucosal and more recently submucosal resection. In Japan, the first description of endoscopic polypectomy as a treatment for pedunculated or semipedunculated EGC was presented in 1974 and in 1984 Tada and colleagues reported a revolutionary Endoscopic Mucosa Resection (EMR) technique called strip biopsy [2]. The step forward was a new endoscopic resection technique that included the submucosal cut of lesions with special endoscopic knives. It was developed in the late 1990s and it has recently been classified as Endoscopic Submucosal Dissection (ESD) to distinguish it from conventional EMR. The endoscopic procedures together with the development of new staging technology allow this cancer to be treated with a similar efficacy, less invasively and in a more cost-effective manner compared to open surgery [5]
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