Systematic Endoscopic Approach to Early Gastric Cancer in Clinical Practice

Abstract

Early gastric cancers (EGCs) are defined as gastric cancers confined to the mucosa or submucosa, regardless of regional lymph node metastasis. The proportion of EGCs has been increasing due to the increase in screening endoscopy for gastric cancers; therefore, the paradigm shift from surgical resection to endoscopic resection as a treatment modality for selected EGCs is accelerating. For successful endoscopic resection of EGCs, it is important to detect EGCs at an early stage and to accurately predict the histological type, depth of invasion, and horizontal margins of the tumor. The diagnostic process of EGCs can be divided into three steps: presence diagnosis, qualitative diagnosis, and quantitative diagnosis. The presence diagnosis of EGCs is mainly based on two endoscopic findings: a well-demarcated lesion and irregularity in the color/surface pattern. Qualitative diagnosis refers to the prediction of histological type, which is mainly possible based on the macroscopic shape and color of the lesion. Quantitative diagnosis of EGCs consists of predicting the depth of invasion by detailed examination of the macroscopic morphology and determining horizontal margins using chromoendoscopy. Although advanced diagnostic modalities, such as endosonography or magnifying endoscopy, are helpful for the qualitative and quantitative diagnosis of EGCs, these modalities are not available in most hospitals. Therefore, it is still very important to evaluate EGCs systematically during conventional endoscopy for successful endoscopic treatment.

Value of quantitative microsurface structure analysis for evaluating the invasion depth of type 0–II early gastric cancer

“…M tumors are suitable for endoscopic treatment. Studies have shown that the traditional endoscopic assessment of the total invasive depth of early gastric cancer was 55.5–64.8% and 55.5–69% for M and 47–88% for SM 6,7,22,23 . Abe used the DPS system to predict the invasion depth of early gastric cancer; the results showed that the accuracy of DPS assessment was higher than that of the traditional method.…”

Increasing trend of <i>Helicobacter pylori</i>-uninfected gastric cancer without gastric atrophy

“…Histological types of H. pylori -uninfected gastric cancers included signet ring cell carcinoma (12.5%) and fundic gland-type adenocarcinoma (25%). The endoscopic features of signet ring cell carcinoma include pale-colored, superficial, flat or depressed lesions located in the lower-to-middle third of the stomach.‍ ( 22 ) The endoscopic features of fundic gland type adenocarcinoma include flat elevated lesions similar to a submucosal tumor, with a whitish color, located in the middle-to-upper third of the stomach, and without atrophy in the background mucosa.‍ ( 23 ) It is necessary to consider these characteristics during endoscopic screening.…”

Small nonfunctional pancreatic neuroendocrine neoplasms: Time for a step-up treatment approach?

“…This treatment strategy has been previously utilized for other preneoplastic and early gastrointestinal cancers, such as gastric and colonic polyps/early carcinoma and low- and high-grade dysplasia and early cancer in Barrett’s esophagus, in which endoscopic resection procedures have been a major breakthrough able to avoid more invasive surgeries, especially esophagectomy and gastrectomy. [ 31 32 33 ]…”