Clinical practice guideline for endoscopic resection of early gastrointestinal cancer

Abstract

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

“…The macroscopic classification was divided into elevated (0-I), flat (0-II), and depressed (0-III) types according to the Paris classification of superficial neoplastic lesions in the digestive tract[ 17 ]. En bloc resection was defined as resection of the lesion in a single piece, and complete resection was defined as resection of a tumor without histological evidence of tumor cell involvement on the lateral and vertical resection margins[ 18 ].…”

Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice

“…2 According to the JNET classification, hyperplastic polyps or sessile serrated lesions, adenomas or carcinomas with low-grade structural atypia, highgrade intramucosal neoplasia or shallow submucosal invasive cancer, and deep submucosal invasive cancer are classified as types a, 2A, 2B, and 3, respectively. 3,4 Although these classifications increase the histological predictive value, concerns still exist regarding disagreements among observers because of their subjective nature, which requires training and abundant endoscopic experience. The need for a reliable and objective system has fueled the development of software that automatically evaluates NBI colonoscopy images for histological prediction of polyps.…”

“… 2 According to the JNET classification, hyperplastic polyps or sessile serrated lesions, adenomas or carcinomas with low-grade structural atypia, high-grade intramucosal neoplasia or shallow submucosal invasive cancer, and deep submucosal invasive cancer are classified as types a, 2A, 2B, and 3, respectively. 3 , 4 …”

Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

“…There have been several guidelines providing recommendations on the diagnosis and management of patients at risk of gastric cancer, as well as minimum standards for standard and image-enhanced endoscopy [ 57 , 113 , 149 , 150 , 151 , 152 ]. Standards have included recommendations for minimal inspection time of those with premalignant lesions (7 to 10 min) [ 153 , 154 , 155 , 156 , 157 ], as well as learning curves for training [ 155 ].…”