Principles of Endoscopic Resection of Early Gastric Cancer

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COURSE VIDEO

Course: ⏱ Quick Tip Videos + Five Minute Fridays

Endoscopic Resection of Early Gastric Cancer

Endoscopic Resection of Early Gastric Cancer

I. Introduction

• Overview of endoscopic treatment for early gastric cancer

II. Early Gastric Cancer

• 5-year survival rate: 86-98%

• No difference in survival between surgery and endoscopic resection

III. Endoscopic Mucosal Resection (EMR)

• Objective: Complete removal of the lesion (R0 resection/oncological resection)

• Methods of EMR

• Limitations of EMR

  • Incomplete resection rate: ~27%

  • Risk factors for incomplete resection:

    • Size greater than 15mm

    • Poor differentiation

IV. Endoscopic Submucosal Dissection (ESD)

• Preferred method for early gastric cancer

• Steps for ESD:

  • Detect lesion

  • Mark borders

  • Incise borders

  • Dissect lesion

  • Resect lesion

  • Analyze lesion

• Equipment for ESD

  • Various types of knives

  • IT knife

  • IT knife nano

V. Case Study: ESD in 1000 Patients

• Demographics:

  • 952 patients

  • 502 male/450 female

  • Average age: 62.1 years

• Results:

  • 95% en bloc resection rate

  • 88% curative resection rate

  • 4.1% piecemeal resection rate

  • 1.8% lateral incomplete resection rate

• Therapy duration: 47.8 ± 38.3 minutes

• Complications:

  • Bleeding: 15.6%

  • Perforation: 1.2%

  • Need for surgery: 0.2%

• No lethality

• Risk factors:

  • Proximal localization

  • Scar retraction

  • Poor differentiation

  • Size greater than 40 mm

VI. Take-Home Messages

• Gastric cancer is often missed during endoscopy.

• Training and methodical approach to endoscopy is essential for detection.

• White light and chromoendoscopy are key modalities.

• Endoscopic resection using ESD is standard of care for early gastric cancer.