[Radical endoscopic treatment of early gastric cancer-indication for and evaluation of endoscopic resection].

In the endoscopic treatment of early gastric cancer, it is absolutely necessary to adapt a radical approach. The indication for this technique in 545 surgically resected cases of single gastric cancer was studied and technical evaluation was made of endoscopic resection (ER) in 98 of early gastric cancer lesions. Except for 2 special lesions of early gastric cancer, invasion depth m and sm minute invasion [sm(+)] cancer did not show lymph node metastasis [n(+)], but this was recognized in sm(++) cancer showing more than moderate invasion and which was deeper than pm cancers. The applicable lesions were selected excluding the n(+)-risk group with invasion deeper than sm(++) based on histological type, macroscopic type, size and the presence or absence of ulcers(Ul). These were differentiated type II a less than 2 cm in size, differentiated type Ul(-) II c of less than 1 cm and undifferentiated type Ul(-) II c of less than 5 mm in areas excluding the fundic gland mucosa. Our method of ER is endoscopic double snare polypectomy. II a or II c lesion is artificially squeezed into a pedunculated form. The cutting snare is placed over the peduncle, the grasping forceps are replaced with another snare to grasp the tumor firmly. Then cutting snare is applied to include sufficient normal mucosa surrounding the lesion and coagulating current is passed through to slowly resect the ared. The 1st-ER healing ratio, remnant ratio and recurrence ratio of standard ER in 55 II a and 30 II c lesions were 83.5, 12.9 and 3.5% respectively. The recurrent cases were retrospectively found originals in the remnant. Among remnant and recurrences, the 2nd-ER healing ratio was 43% (6/14) and surgically treated cases were 8 (6 inapplicable cases), the final ER healing ratio being 90.6% and satisfactory. Most of the remnant lesions were II a of more than 2 cm, and II c of more than 1 cm for differentiated type and II c for undifferentiated type. As ER could not be applied to these lesions, its indication was confirmed to be technically satisfactory.