Is curative endoscopic treatment of early gastric cancer possible?

Fifty-four lesions found in 51 cases of early gastric cancer were treated with the Nd:YAG laser, N2 dye laser, local injection of ethanol, polypectomy and a combination of these methods between November, 1980 and July, 1986. Among these lesions, 34 were followed for more than one year with the endoscope. In 86% of the lesions treated, no recurrence of cancer was detected during the observation period, nor were there any deaths from gastric cancer. An analysis of the results showed that local cure of early gastric cancer in the mucosal layer could be accomplished with many kinds of endoscopic devices and that the difficulties for curative treatment depended on tumor localization and size. Further, we were able to assess local cure after endoscopic treatment on the basis of the endoscopic features of the tumor; local cure presents as a scarred stage with a smooth surface and with no abnormal granules or irregular redness. At present, endoscopic treatment should however, be limited to inoperable cases, since we cannot definitively diagnose lymph node metastasis or depth of cancer invasion.