Endoscopic submucosal dissection for early gastric cancer: A review of comparative perspectives on treatment outcomes vs gastrectomy

Table 4 Comparison table of regional guidelines on indications for endoscopic submucosal dissection in early-stage gastric cancer by subtype (Korean Gastric Cancer Association/Japanese Society of Gastrointestinal Endoscopy/MAPS III)

Tumour classification and characteristics	South Korea (Korean Gastric Cancer Association 2024)	Japan (Japanese Society of Gastrointestinal Endoscopy 2021)	Europe (MAPS III 2025)
Differentiated intraepithelial carcinoma	-	-	-
No ulceration; diameter ≤ 2 cm	Standard indications	Absolute indications	Recommended for use
No ulceration, diameter > 2 cm	Provided that the criteria for curative resection are met	Absolute indications	Recommended for use
Accompanied by ulcer formation, diameter ≤ 3 cm	Provided that the criteria for curative resection are met	Absolute indications	Recommended for use
Associated with ulcer formation, diameter > 3 cm	Endoscopic submucosal dissection resection is not recommended	Relative indications	Not recommended
Undifferentiated intraepithelial carcinoma	-	-	-
No ulceration; diameter ≤ 2 cm	This should be chosen with due care following careful consideration	Absolute indications	This could be considered for implementation
Submucosal invasive carcinoma (SM1, depth of invasion ≤ 500 μm)	-	-	-
Differentiated, longest diameter ≤ 3 cm	Following pathological assessment, the patient is deemed eligible for curative resection	Relative indications	This could be considered for implementation