Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3944
Peer-review started: September 4, 2014
First decision: October 14, 2014
Revised: October 22, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: April 7, 2015
Core tip: Papillary adenocarcinoma-type early gastric cancers (EGCs) are classified as differentiated-type adenocarcinoma and, therefore, treated with endoscopic submucosal dissection (ESD) according to the same indication criteria as other differentiated-type adenocarcinoma, such as tubular adenocarcinoma. However, the rate of lymph node metastasis under the current ESD indication criteria was somewhat high, and more than half of the patients who underwent ESD as a primary treatment for papillary carcinoma-type EGC ultimately achieved out-of-ESD indication. Therefore, the use of ESD should be more carefully considered for papillary adenocarcinoma-type EGCs with suspected ESD indication after pre-treatment work-up.