Gastrointestinal early cancers: Endoscopic diagnosis and therapy

The improvement of endoscopic techniques support the detection of early can cers of the gastrointestinal tract. The endoscopic removal of neoplasias, i n particular by endoscopic mucosal resection (EMR), has become the gold sta ndard for early digestive cancer therapy in Japan. In many cases surgical r esection with lymphadenectomy, which is the current standard, is considered an overtreatment and can be replaced by endoscopic resection. A more wides pread use of these techniques in Western countries, however, is only possib le, if early cancer is detected much more frequently. Besides the need to i mprove the endoscopist's ability to recognize early neoplasias, various anc illary methods such as dye spraying techniques, magnifying and fluoroscopic endoscopy, will increase the rate of detection of early cancer. EMR, toget her with photodynamic therapy and limited surgery, will have to be part of a strategy in the therapy of early gastric cancer.