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World J Gastrointest Oncol. Jun 15, 2021; 13(6): 560-573
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.560
Current indications for endoscopic submucosal dissection of early gastric cancer
Zhi Zheng, Jie Yin, Xiao-Ye Liu, Xiao-Sheng Yan, Rui Xu, Meng-Yi Li, Jun Cai, Guang-Yong Chen, Jun Zhang, Zhong-Tao Zhang
Zhi Zheng, Jie Yin, Xiao-Ye Liu, Xiao-Sheng Yan, Meng-Yi Li, Jun Cai, Jun Zhang, Zhong-Tao Zhang, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Rui Xu, Guang-Yong Chen, Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zheng Z, Yin J, Liu XY, and Yan XS contributed equally to this work; Zheng Z, Yin J and Yan XS carried out the studies, participated in collecting the data, and drafted the manuscript; Xu R, Liu XY, Li MY, and Cai J participated in study design; Zhang J, Yin J, Chen GY, and Zhang ZT helped to draft the manuscript; all authors read and approved the final manuscript.
Supported by Beijing Municipal Science & Technology Commission, No. D171100006517003 and No. Z181100001718223; Research Foundation of Beijing Friendship Hospital, Capital Medical University, No. Y2018-3; Beijing Municipal Administration of Hospitals Incubating Program, No. PX2020001; and Digestive Medical Coordinated Development Center of Beijing Hospital Authority, No. XXX0102.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Zhang, MD, PhD, Chief Doctor, Director, Surgeon, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. zhangjun5986@ccmu.edu.cn
Received: February 5, 2021
Peer-review started: February 5, 2021
First decision: March 29, 2021
Revised: March 31, 2021
Accepted: May 22, 2021
Article in press: May 22, 2021
Published online: June 15, 2021
Abstract

The development of endoscopic treatment technology has further promoted the minimally invasive treatment of early gastric cancer (EGC). Endoscopic treatment has achieved better therapeutic effects in terms of safety and prognosis and is the preferred treatment method for patients who meet the indications for endoscopic treatment. However, the consequent problem is that some patients receiving endoscopic treatment may undergo non-curative resection, and the principle of follow-up management for non-curative resection patients deserves further attention. In addition, there are still debates on how to improve the accuracy of clinical staging, select a reasonable treatment method for patients who meet the expanded indications for endoscopic treatment, manage patients with positive endoscopic surgical margins, conduct research on function-preserving surgery, and manage the treatment of EGC under the current situation in China. Consequently, we aim to review current indications for endoscopic submucosal dissection of EGC in order to better inform treatment options.

Keywords: Early gastric cancer, Endoscopic submucosal dissection indications, Non-curative resection, Salvage surgery, Function-preserving surgery

Core Tip: Gastric cancer is a worldwide public health problem with a lower cure rate and worse prognosis. With the improvement of people’s health awareness and the popularization of physical examination, the detection rate of early gastric cancer is increasing each year. Helicobacter pylori and Epstein-Barr virus are important pathogenic factors for gastric cancer. For patients who meet with the absolute and expanded indications for endoscopic treatment, endoscopic submucosal dissection can have the same therapeutic effect as surgery while reducing surgical trauma. For non-curative resection, laparoscopic subtotal gastrectomy or function-preserving gastrectomy can be performed based on the patient’s condition.