Epstein-Barr Virus-associated Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Possible Candidate for Extended Criteria of Endoscopic Submucosal Dissection

Abstract

A 73-year-old man visited our hospital for the treatment of an early gastric cancer (GC) lesion. We performed en bloc resection using endoscopic submucosal dissection (ESD) for his GC lesion. The present GC lesion was Epstein-Barr virus (EBV)-associated poorly differentiated-type adenocarcinoma invading into the submucosal layer. Recently, accumulating data has shown that the risk of lymph node metastasis from early EBV GC without local lymphovascular infiltration is low. The present patient has been in good health for over three years since ESD. Some cases of early EBV GC with invasion into the submucosal layer may be candidates for further extension of the ESD criteria.

Endoscopic and pathologic motifs for the clinical diagnosis of Epstein–Barr virus‐associated gastric cancer

“…EBV testing may be especially needed in inoperable advanced GC cases or early GC cases not included in the present curative ESD indication. 7 , 13 …”

“…For such endoscopic false‐positive lesions, endoscopic ultrasonography may be useful. 13 , 19 It is clear that further progress in endoscopic diagnosis of EBVaGC is needed.…”

“…Thus, further extension of the criteria of ESD for early EBVaGC should be discussed. 9 , 10 , 11 , 12 , 13 In many cases, EBVaGC is located in the upper part of the stomach or remnant stomach. Therefore, such extension of the ESD criteria may prevent possible excessive surgery such as total gastrectomy.…”

“…Accumulating data show that the risk of lymph node metastasis from early EBVaGC is low. Thus, further extension of the criteria of ESD for early EBVaGC should be discussed 9–13 . In many cases, EBVaGC is located in the upper part of the stomach or remnant stomach.…”

Epstein–Barr virus-associated gastric cancer: disease that requires special approach

“…Early EBV( +) GCs are more likely to form well-demarcated, nodular lesions in the submucosa with less fibrosis and no lymph-node metastasis, as opposed to EBV-negative gastric carcinoma, making them more available for endoscopic submucosal resection [9]. Indeed, favorable clinical outcomes in early EBV( +) GC treated with endoscopic submucosal dissection have been reported repeatedly EBV( +) GC [10,11]. Among all molecular subtypes of GI adenocarcinomas, EBV( +) GC has the greatest immunogenicity [12].…”