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.

This prospective study was designed to clarify the association between the incidence of falls and physical fitness in healthy community-dwelling elderly people without history of fall-related injuries within 1-5 years before the baseline assessment. Six hundred and one elderly subjects aged 60-79 years who lived independently participated in baseline assessments from March 2002 to March 2004, and were followed up for one year to detect falling. Demographic items (age and sex), chronic disease, self-rated health, difficulty in performing any activity, tendency to stay at home, body mass index (BMI), %vital capacity, handgrip and knee extension strength, stepping rate, one-leg standing with eyes opened, trunk flexion at sitting position, maximum walking speed, instrumental activity of daily living (IADL), and General Health Questionnaire (GHQ30) were assessed at baseline. Four hundred and eighty-one participants (80.0%) completed the 1-year follow-up.The fall incidence was 13.1%. In men, fallers had lower BMI and decreased maximum walking speed, however, neither showed significant odds ratio (OR) for fall. In women, fallers had lower knee extension strength and the ratio of weak side to strong side (WS/SS ratio) in knee extension strength compared to non-fallers. The age-adjusted OR for fallers in the lowest quartile (knee extension strength＜0.681kg/BW) was 3.07 (95%CI : 1.02-9.22) compared to highest quartile (＞0.980 kg/BW), while the multiple-adjusted OR was not significant (OR＝2.88, 95%CI : 0.94-8.79). However, the multiple-adjusted OR for fallers in the lowest quartile of the WS/SS ratio in knee extension strength (＜0.771) was 4.49 (95%CI : 1.40-14.37) compared to highest quartile (＞0.947).As for conclusion, without history of fall-related injuries, only a weak association between falls and physical fitness was observed in men. In women, the unbalanced knee extension strength was associated with falls. The WS/SS ratio in knee extension strength might be a key factor in predicting falls in women.