Treatment modalities for early gastric cancer

Abstract

Different treatment modalities have been proposed in the treatment of early gastric cancer (EGC). Endoscopic resection (ER) is an established treatment that allows curative treatment, in selected cases. In addition, ER allows for an accurate histological staging, which is crucial when deciding on the best treatment option for EGC. Recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have become alternatives to surgery in early gastric cancer, mainly in Asian countries. Patients with "standard" criteria can be successfully treated by EMR techniques. Those who meet "expanded" criteria may benefit from treatment by ESD, reducing the need for surgery. Standardized ESD training system is imperative to promulgate effective and safe ESD technique to practices with limited expertise. Although endoscopic resection is an option in patients with EGC, surgical treatment continues to be a widespread therapeutic option worldwide. In this review we tried to point out the treatment modalities for early gastric cancer.

Keywords: Early gastric cancer; Endoscopic mucosal resection; Endoscopic submucosal dissection; Gastrectomy; Pathological staging.

Figure 1

Endoscopic mucosal resection with Multiband Ligator for early gastric cancer. A: Argon plasma coagulation is used for marking early gastric cancer; B: A multiband ligator was used to create a pseudopolyp and it is removed by a minipolypectomy snare using pure coagulating current; C: Residual scar after Multiband Mucosectomy.

Figure 2

Different types of devices, specific for each step of the Endoscopic submucosal dissection procedure. A: ITknife-2; B: Hook knife; C: Dual knife; D: Grasper for haemostasis. (Courtesy of Olympus Medical Systems,Tokyo, Japan).