ENDOSCOPIC RESECTION OF EARLY GASTRIC-CARCINOMA - RESULTS OF A RETROSPECTIVE ANALYSIS OF 308 CASES

The purpose of this study was to define the indications and limitation s of endoscopic resection (ER) of early gastric carcinoma (EGC). Over the 15 year period from 1978 to 1992, 308 early cancers were resected endoscopically either through a single operative intervention or in st ages. Of 266 lesions resected in a single step, 222 (85 %) entered rem ission. Forty-four cases had either residual or recurrent lesions. The size, histology and location affected the curability; 89 % of Type II a lesions less than 2 cm were resected curatively, while only 50 % of those larger than 2 cm were resected completely. In Type IIc, 83 % of lesions less than 1 cm and 57 % of those greater than 1 cm were excise d completely by ER. In Type IIc, curative ER was possible in 85 % of d ifferentiated carcinomas and 43 % of undifferentiated carcinomas. The rate of incomplete resection was higher for lesions of the anterior or posterior wall, than for those of the lesser curvature. Semiserial se ctions of the resected specimens made at 2 mm intervals, indicated tha t, if the positive margin was confined to one section, cure may be pos sible by the burning effect. Follow-up showed that there was no single case undergoing endoscopic resection which subsequently died of gastr ic carcinoma. The lesions that are suitable for ER comprise Type IIa E GC of less than 2 cm in diameter, and Type IIc differentiated adenocar cinoma of less than 1 cm. Lesions in which the entire margin is diffic ult to observe by front-view endoscopy should be smaller than dermed b y the above criteria.