J Gastric Cancer.  2010 Jun;10(2):49-54.

Expansion of Indication for Endoscopic SD in Early Gastric Cancer

  • 1Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea. hwoonymd@gmail.com


Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than 500 micrometer). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.


Early gastric cancer; Endoscopic submucosal dissection; Expanded indication
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