Lessons from Japan--endoscopic management of early gastric and oesophageal cancer

A significant proportion of gastric and oesophageal cancers are diagnosed at an early stage in Japan. Early cancer is not obvious to the untrained eye as the mucosal changes are subtle. Better awareness by endoscopists of the different appearances of early cancer probably contributes significantly to this high incidence in Japan. Routine use of chromoendoscopy in high risk patients is also helpful. Survival figures after open surgery for these early cancers are excellent. Although the mortality of open surgery for carcinoma of the stomach and oesophagus is low, the morbidity is still considerable. A stage of early cancer, when the lesion is limited to the mucosa has been demonstrated to have minimal risk of metastatic spread (even to the local lymph nodes). These lesions can be reliably diagnosed with the help of endoscopic ultrasound. Once diagnosed, endoscopic mucosal resection can be performed with low morbidity. This provides tissue for histological evaluation, which is a definite advantage over other ablative methods used to treat early gastric and oesophageal cancer. Gastric cancers which are difficult to resect endoscopically, can be dealt with laparoscopically with equally satisfactory results