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World J Gastroenterol. Oct 7, 2014; 20(37): 13273-13283
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13273
Ever-changing endoscopic treatment for early gastric cancer: Yesterday-today-tomorrow
Mi-Young Kim, Jun-Hyung Cho, Joo Young Cho
Mi-Young Kim, Jun-Hyung Cho, Joo Young Cho, Digestive Disease Center, Soonchunhyang University Hospital, Seoul 140-887, South Korea
Author contributions: Kim MY wrote the paper; Cho JH collected the reference and data; Cho JY provided the advice for this work.
Correspondence to: Joo Young Cho, MD, Digestive Disease Center, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-887, South Korea.
Telephone: +82-2-7099202  Fax: +82-2-7099696
Received: October 28, 2013
Revised: February 10, 2014
Accepted: April 30, 2014
Published online: October 7, 2014

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

Core tip: Endoscopic treatment of early gastric cancer (EGC) has been evolved along with the expansion of ESD indication and toward the question of how to achieve accurate risk assessment of lymph node metastasis (LNM). To achieve curative endoscopic treatment, not only accurate endoscopic diagnosis but precise selection of the patient of EGC without LNM should be preceded. Recently, endomicroscopy has been introduced to provide precise microscopic visualization of histology. Moreover, sentinel node navigation surgery combined ESD and hybrid natural orifice transluminal endoscopic surgery have been reported as a new minimally invasive treatment option for the EGC patients with high risk of LNM.