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Review
, 20 (37), 13273-83

Ever-changing Endoscopic Treatment for Early Gastric Cancer: Yesterday-Today-Tomorrow

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Review

Ever-changing Endoscopic Treatment for Early Gastric Cancer: Yesterday-Today-Tomorrow

Mi-Young Kim et al. World J Gastroenterol.

Abstract

Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer (EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection (ESD) has been widely used for treatment of EGC along with expanding ESD indication, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis (LNM). Recently, new techniques including ESD or endoscopic full-thickness resection combined with sentinel node navigation enable minimal tumor resection and a laparoscopic lymphadenectomy in cases of EGC with high risk of LNM. This review covers the development and challenges of endoscopic treatment for EGC. Moreover, a new microscopic imaging and endoscopic techniques for precise endoscopic diagnosis and minimally invasive treatment of EGC are introduced.

Keywords: Confocal laser endomicroscopy; Early gastric cancer; Endoscopic resection; Hybrid natural orifice transluminal endoscopic surgery; Sentinel node navigation.

Figures

Figure 1
Figure 1
Features of confocal endomicroscopy. A: Normal gastric epithelium, round pattern of normal crypts is observed; B: Dysplasia, dark epithelium with irregular and varying thickness is observed; C: Differentiated adenocarcinoma, disorganized epithelium with dark and irregular glands is observed; D: Undifferentiated adenocarcinoma, dark and irregular cells with no identifiable glandular structures are observed.
Figure 2
Figure 2
Endoscopic submucosal dissection with sentinel node navigation. A: Marking for endoscopic submucosal dissection is performed around the tumor; B: Indocyanine green is injected into the submucosal layer around the tumor for sentinel node navigation; C: Sentinel node harvest is performed by laparoscopic pick-up biopsy; D: Endoscopic submucosal dissection is performed.
Figure 3
Figure 3
Full-thickness gastric resection. A: An elevated lesion is noted at the lesser curvature of upper body; B: The lesion becomes distinct by chromoendoscopy using acetic acid and indigocarmin; C: For sentinel node navigation, indocyanine green is injected into the submucosal layer after marking around the tumor; D: Endoscopic full-thickness resection is performed after sentinel node harvest and regional lymph node dissection; E: Final resection is performed with laparoscopy; F: Gastric closure is achieved with laparoscopy.

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