Detection of early gastric cancer in an aggressive endoscopy unit

Early Gastric Cancer (EGC) is defined as tumor invasion limited to the mucosa and submucosa, irrespective of regional lymph node involvement. These patients have five-year survival rates in excess of 90 per cent. Although frequently seen in Japan, the detection of ECG remains uncommon in the United States. Twenty-two patients with EGC over a 15-year period were reviewed. EGC was identified in 0.5 per cent (1/207) of all gastric cancers before the widespread use of endoscopy (1972-1979) in our institution and in 16.5 per cent (21/127) of such patients after endoscopy began to replace barium contrast studies (1980-1987). Radiographic studies were performed initially in 14 out of 22 patients with EGC, and in ten patients were reported as normal. Endoscopy was used to make the diagnosis of EGC in 21 of 22 patients. Nineteen of the 22 patients are currently alive and free of disease (86%) with a mean follow-up of 3.4 years (range 6 months to 12 years). Our experience has paralleled that of the Japanese in that, with the adoption of fiberoptic endoscopy as the first-line diagnostic modality in patients with GI complaints, the detection of EGC has significantly increased.