Current status of endoscopic mucosal resection for early gastric cancer in Korea

Kim, Jae J; Kim, Beom Jin

Abstract

Endoscopic mucosal resection (EMR) has become a standard treatment for selected cases of early gastric cancer (EGC) because of its minimal invasiveness and comparable survival outcomes to surgical resection. The currently recognized indications of EMR for EGC are differentiated mucosal tumor < 2 cm for elevated and < 1 cm for flat and depressed type lesions. Recently, expanded criteria have been proposed in Japan. However, its wide acceptance is being limited in Korea by the lack of long-term outcome data and difficulty in pathological interpretation. In Korean multicenter study including 514 EGC cases resected by EMR, en bloc and complete resection rates were 71.8% and 77.6%, respectively. Local recurrence was detected in 24 cases (6.0%) after complete resection during the median 23.5 months of follow-up. Bleeding and perforation rates were 13.8% and 0.6%. Recently, endoscopic submucosal dissection (ESD) method was introduced to overcome the size limitation of EMR and consequently to improve en bloc resection rate. This technique has been widely accepted in Korea these days. In Korean multicenter study including 534 EGC cases treated by ESD, en bloc and complete en bloc resection rates were 95.3% and 87.7%, respectively. Bleeding and perforation rates were 15.6% and 1.2%. To make EMR and ESD more reliable and safer methods of treating EGC, more long-term follow-up data and standardization of techniques and pathological interpretation were required.