Endoscopic mucosal resection for early gastric cancer

Abstract

Progress in the detection of early gastric cancer has made endoscopic mucosal resection (EMR) possible for the treatment of gastric cancer instead of only conventional surgical resection. The most commonly employed modalities include strip biopsy, double snare polypectomy, and resection with combined use of highly concentrated saline and epinephrine, and resection using a cap. The indications should be strictly limited to the differentiated IIa type (the slightly elevated type) that is smaller than 2 cm, or the differentiated IIc type (slightly depressed type) without ulcer formation and smaller than 1 cm. Both of these entities are thought to have a negligible risk of lymph node metastasis. Prognosis after this treatment is comparable that of surgical resection for early gastric cancer in completely resected cases. EMR also permits local resection in elderly patients with various complications who would be at risk for conventional surgical operations. EMR should be encouraged for treatment of gastric cancer if the indications are strictly chosen. Semin. Surg. Oncol. 17:108–116, 1999. © 1999 Wiley‐Liss, Inc.

Endoscopic mucosal resection using a cap-fitted endoscope improves tissue resection and pathology interpretation: an animal study

“…Endoscopic mucosal resection (EMR) is an important method of diagnosing and managing precancerous and early cancerous lesions of the esophagus, stomach, and colon [1][2][3]. It is being increasingly used in North America and Europe.…”

Endoscopic mucosal resection for gastric epithelial neoplasms: a study of 39 cases with emphasis on the evaluation of specimens and recommendations for optimal pathologic analysis

“…Larger studies have reported an overall recurrence rate of about 10% (0% when resection is complete and 35.3% when the resection was incomplete). 7 However, our small series with only a few examples of persistent or recurrent disease and no progression to advance adenocarcinoma confirm the validity of endoscopic mucosal resection as an efficient therapeutic option when the indications are strictly chosen. 9 Severe complications following this endoscopic technique are rare.…”

Endoscopic mucosal resection for gastric epithelial neoplasms: a study of 39 cases with emphasis on the evaluation of specimens and recommendations for optimal pathologic analysis

“…Pioneered in Japan in the 1980s, endoscopic mucosal resection is now a routine technique available in most large Japanese medical centers where it is the therapy of choice for 70% of early gastric cancers. 7,8 The current guidelines recommend this type of resection for intestinal-type gastric cancers measuring less than 2 cm and with negative lymph nodes. 9 Under these guidelines, this technique provides outstanding long-term survival.…”

“…In addition, it offers a superior quality of life compared to gastrectomy. 7,10,11 In the West, endoscopic mucosal resection of gastrointestinal neoplasms is experiencing a slower development. Several series have reported the experience of few centers with regard to the management of esophageal, rectal and gastric neoplasms.…”