Recent Advances in Endoscopic Submucosal Dissection for Gastric Cancer: Focusing on Expanded Indications and...

Area of Science:

• Gastroenterology
• Oncology
• Surgical Endoscopy

Background:

• Endoscopic resection (ER) for early gastric cancer (EGC) indications and curability criteria are expanding globally.
• Korea has the strictest ER indications, while curability criteria are similar across Korea, Europe, and Japan.
• Additional surgery post-noncurative resection is standard but underutilized in older patients.

Purpose of the Study:

• To review current evidence on ER and endoscopic submucosal dissection (ESD) for EGC.
• To discuss challenges and advancements in managing EGC, particularly in older adults.
• To provide an evidence-based perspective for optimal EGC patient management.

Main Methods:

• Review of current literature on ER and ESD for EGC.
• Analysis of indications, curability criteria, and treatment strategies.
• Evaluation of risk-scoring systems and evolving endoscopic techniques.

Main Results:

• Risk-scoring systems may aid ER indications and curability assessment in older patients, but specific recommendations are lacking.
• Non-gastric cancer mortality and quality of life are crucial considerations in older EGC patients.
• Advancements in ESD, including traction and multibending endoscopes, enhance safety and reliability.
• Promising closure methods exist for post-ESD bleeding, and image-enhanced endoscopy may improve technical success.

Conclusions:

• Optimal management of EGC requires considering patient-specific factors, especially in older populations.
• Evolving endoscopic techniques like ESD offer improved outcomes for selected EGC cases.
• Further research is needed to refine ER indications and ESD management strategies for diverse patient groups.