The indications for endoscopic resection (ER) and the criteria for the curability of early gastric cancer (EGC) have been expanding. Among Korea, Japan, and Europe, Korea has the most strictly defined indication for ER, followed by Europe and Japan, whereas the curability criteria are relatively similar. Additional surgery is the standard treatment after noncurative resection; however, it is not frequently performed in older patients in clinical practice. Several risk-scoring systems have been developed to further stratify the risk of lymph node metastasis after noncurative resection, and they may help refine the indications for ER and curability assessment in older patients. Nevertheless, the current evidence remains insufficient to establish recommendations specific to this population. In older patients, most deaths are attributable to non-gastric cancer-related causes, regardless of the post-resection treatment strategy. Therefore, in addition to gastric cancer-specific mortality, non-gastric cancer-related mortality and quality of life should be considered.Endoscopic submucosal dissection (ESD) techniques continue to evolve. Traction methods and multibending endoscopes are useful for achieving safe and reliable ESD in selected cases.Although no intervention has been proven effective in reducing delayed bleeding after gastric ESD in randomized controlled trials, several closure methods have shown promising results in retrospective or phase II studies. Furthermore, novel image-enhanced endoscopies may help improve the technical success of gastric ESD. This review provides an evidence-based perspective that may guide optimal management of patients with EGC.

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established.

PURPOSE: Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication. MATERIALS AND METHODS: We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and ¹³C-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint. RESULTS: Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE. CONCLUSIONS: We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).
Atrophy ; Breath Tests ; Carcinogenesis ; Congo Red ; Diagnosis ; Digestive System ; Endoscopy ; Gastric Mucosa* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Information Services ; Optical Imaging ; Stomach Neoplasms

We began gastric mass survey at our hospital in May, 1980. During 3 years and 8 months since then, (May, 1980-December, 1983) we performed screening examinations to 16, 341 people by indirect radiography, and checked 2, 824 cases (17.3%) for thorough examination. Among these cases, 2, 083 (73.8%) received endoscopic examination actually, and 55 cases of gastric cancer were discovered. The discovery rate of gastric cancer was 0.336 per cent.
35 cases of these 55 gastric cancer were operated in the surgical department of our hospital. 34 cases were resected (rate of resection was 97.1%) and 33 cases were resected curatively (rate of curative resection was 94.3%). These results were better than that of gastric cancer cases from out-patient clinic of the same period. The results of cases from out-patient clinic of our hospital were: total number of cases 321, resected cases 254 (79.1%), curative resection 189 cases (58.9%), respectively.