Endoscopic Therapy of Early Gastric Cancer —Comparison of Endoscopic Mucosal Coagulation and Resection—

Abstract

Abstract: The clinical efficacy of various methods of endoscopic treatment was evaluated in 70 patients with early gastric cancer. The treatments included using an Nd‐ YAG laser on 22 patients (2 IIa cases, 3 IIa + IIc cases and 17 IIc cases), a heater probe on 2 patients (IIc) and endoscopic mucosal resection (EMR) on 46 patients (13 I cases, 15 IIa cases, 2 IIa + IIc cases and 16 IIc cases). Laser irradiation and the heater probe method (endscopic mucosal coagulation; EMC), which cause coagulation and necrosis to lesions using heat energy, were found to be successful for well differentiated adenocarcinoma confined to the mucosa even if the size of the lesions was 20 mm and over. Poorly differentiated adenocarcinoma with lesions 20 mm or smaller reoccurred, and only well differentiated adenocarcinoma with infiltration limited to the mucosa seemed to be treatable endoscopically by EMR. Whether or not total resection was possible was determined with respect to the size and site of lesions in patients treated by EMR. Great therapeutic efficacy was achieved when the lesions were 10 mm or smaller and located in the anterior wall or the greater curvature. Piecemeal resection had to be made in a majority of cases when the lesions measured 10 mm or more or were located in the lesser curvature or the posterior wall. Therefore, endoscopic EMR is recommended if the size of the lesions is 10 mm or less, while EMC must also be considered if the lesions are larger or piecemeal resection is required.