Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Digestion. 2022;103(1):92-98. doi: 10.1159/000518892. Epub 2021 Sep 8.
Endoscopic treatments for gastric cancers have still been progressing even after the great success of endoscopic submucosal dissection (ESD).
In further advancements of ESD, safe and less-invasive procedures are challenged by managing postoperative bleeding, one of the major adverse events in ESD. Covering the mucosal defect after removal of lesions appears reasonable and effective for preventing delayed bleeding from the post-ESD ulcers. Shielding with biodegradable sheets is attempted on clinical trials, which show equivocal results. Although suturing of the mucosal rims is technically challenging, pilot studies demonstrate favorable outcomes for avoiding post-ESD bleeding even in cases at high risk. In cases after noncurative resection of ESD, the selection of patients who truly require additional gastrectomy with lymph node dissection is important to provide necessary surgery. Risk stratification of lymph node metastases and surgery has been developed, which offers tailor-made management to each patient considering the risks and benefits. In surgery, function-preserving gastrectomy to minimize the resection area in both lymphadenectomy and the primary site is clinically introduced. The sentinel node navigation surgery is promising to realize the minimally invasive gastrectomy, and it should strongly fit ESD as well as laparoscopic endoscopic cooperative surgery or endoscopic full-thickness resection, although nonexposure approaches are desirable. Key Message: Development for less-invasive managements on gastric cancer will be continued in step with the advancement of endoscopic treatments.
内镜黏膜下剥离术（ESD）取得巨大成功后，胃癌的内镜治疗仍在不断发展。
在 ESD 的进一步发展中，管理术后出血等主要不良事件是安全、微创治疗面临的挑战。在 ESD 后溃疡处覆盖黏膜缺损以预防延迟性出血似乎是合理且有效的。生物可降解膜的应用已在临床试验中进行尝试，但结果喜忧参半。尽管缝合黏膜边缘在技术上具有挑战性，但初步研究表明，即使在高风险情况下，该方法也可避免 ESD 后出血，从而获得良好效果。对于 ESD 非治愈性切除后的患者，选择真正需要附加淋巴结清扫的胃切除术的患者非常重要，以便提供必要的手术。目前已经制定了淋巴结转移和手术的风险分层，根据风险和获益为每位患者提供个体化的治疗方案。在手术中，为了在淋巴结清扫和原发部位都最小化切除范围，开展了保留功能的胃切除术。前哨淋巴结导航手术有望实现微创胃切除术，它应该与 ESD 以及腹腔镜内镜联合手术或内镜全层切除术紧密结合，尽管非暴露方法是理想的。
随着内镜治疗的进步，将继续开发针对胃癌的微创管理方法。
