ENDOSCOPIC ULTRASONOGRAPHY - A PROMISING METHOD FOR ASSESSING THE PROSPECTS OF ENDOSCOPIC MUCOSAL RESECTION IN EARLY GASTRIC-CANCER

Background and Study Aimes: A recent challenge that is increasingly be ing faced in endoscopy is the use of endoscopic mucosal resection (EMR ) to treat differentiated intramucosal gastric cancers smaller than 2 cm. The usefullness of pretherapeutic endoscopic ultrasonography (EUS) in assessing whether this form of treatment is possible remains contr oversial. Patients and Methods: We retrospectively investigated the va lue of pretherapeutic EUS evaluation in 58 patients with macroscopical ly early gastric cancer that was histologically differentiated and les s than 2 cm in diameter, The patients were classified as negative for endoscopic mucosal resection if EUS showed modifications of the third layer, and as positive if such modifications were not seen. All patien ts underwent radical surgery and the preoperative EUS findings were co mpared with the histological findings. Results: The prevalence of meta static adenopathy was 3% (two of 58), In the lymph-node staging, endos onography had a sensitivity of 8% (neither of two cases), and a specif icity of 93% (52 of 56), In assessing the indication for EMR, EUS had a sensitivity elf 93% (27 of 29), and a specificity of 86% (25 of 29). Conclusions: These results suggest that EUS is a promising method of evaluating the indication for endoscopic mucosal resection in early ga stric cancer, EUS may improve pretherapeutic prediction of tumor curab ility by EMR, and may reduce the need for standard gastrectomy.