Endoscopic Treatment of Superficial Gastric Cancer: Present Status and Future

Abstract

Although the mortality rates of gastric cancer (GC) are gradually declining, gastric cancer is still the fourth leading cause of cancer-related death worldwide. This may be due to the high rate of patients who are diagnosed with GC at advanced stages. However, in countries such as Japan with endoscopic screening systems, more than half of GCs are discovered at an early stage, enabling endoscopic resection (ER). Especially after the introduction of endoscopic submucosal dissection (ESD) in Japan around 2000, a high en bloc resection rate allowing pathological assessment of margin and depth has become possible. While ER is a diagnostic method of treatment and may not always be curative, it is widely accepted as standard treatment because it is less invasive than surgery and can provide an accurate diagnosis for deciding whether additional surgery is necessary. The curability of ER is currently assessed by the completeness of primary tumor removal and the possibility of lymph node metastasis. This review introduces methods, indications, and curability criteria for ER of EGC. Despite recent advances, several problems remain unsolved. This review will also outline the latest evidence concerning future issues.

The Role of Artificial Intelligence in Gastric Cancer: Surgical and Therapeutic Perspectives: A Comprehensive Review

“…Moreover, EUS does not have a significant effect on determining the penetration depth compared with conventional endoscopy, and there are also reports that EUS tends to exaggerate the penetration depth. To determine the depth of invasion through endoscopy, factors such as remarkable redness, uneven surface, submucosal tumor-like margin elevation, and mucosal fold convergence are evaluated, with an accuracy of 82.5% to 96.5% [ 24 25 26 27 ]. This indicates that the depth of penetration can be predicted even with visual information that can be confirmed with the naked eye without using ultrasound and that the image can be learned and used by AI.…”

Endoscopic Oncology: Bridging the Interface Between Gastroenterology and Oncology

“…Endoscopic mucosal resection (EMR) was developed in 1984 initially for the treatment of EGC in Japan. 20 It is currently used for the treatment of esophageal, gastric, small bowel, and colorectal lesions. The main drawback of EMR is the limited size of the specimen that can be resected en bloc.…”

Clinical meaning of sarcopenia in patients undergoing endoscopic treatment

“…Endoscopic treatment is widely performed for early-stage cancers, such as esophageal, gastric, and colorectal cancer. [13][14][15] Endoscopic treatment of early-stage cancer mainly includes endoscopic mucosal resection and endoscopic submucosal dissection (ESD), and ESD is among the recommended treatments according to the existing guidelines for early-stage cancer. [14][15][16] Generally, ESD is less invasive than surgical procedures, resulting in reduced hospitalization duration, decreased likelihood of complications, and preservation of the postoperative quality of life.…”