POSSIBILITIES AND LIMITATIONS OF ENDOSCOPIC RESECTION FOR EARLY GASTRIC-CANCER

Background and Study Aims: To date, the accepted criteria for endoscop ic resection of early gastric cancer have been: a) elevated-type mucos al cancer less than 2 cm in size, and b) depressed-type mucosal cancer without ulceration less than 1 cm in size, In this study, we attempte d to expand these indications. Patients and Methods: Sixty patients wi th early gastric cancer who did not meet the above criteria underwent endoscopic treatment, and were divided into four groups: those with el evated tumours larger than 2 cm with submucosal invasion (group 1 a); those without submucosal invasion (group 1b); those with depressed tum our larger than 1 cm (group 2); and those with ulcerated tumours (grou p 3), The patients were treated with endoscopic resection using a two- channel scope, followed by additional laser irradiation or heater-prob e coagulation (combination therapy) if residual cell were found, Follo w-up was by endoscopy and biopsy for more than tno years. Results: End oscopic treatment was effective in 87% of the patients (52 of 60), hal f of whom required combination therapy, In submucosal cancers, endosco pic treatment nias effective in 76% of patients (13 of 17), However, t umours,vith deep invasion into the submucosa could not be cured, Mucos al cancers larger than 20 mm could be completely resected in 44 % of p atients (eight of 18) using endoscopic resection, but all five patient s with tumours larger than 30 mm had incomplete resections. Conclusion s: These results indicate that complete resection using endoscopic res ection alone is possible in early gastric cancers measuring up to 30 m m in diameter, Tumours larger than 30 mm, and those with deep submucos al invasion, cannot be curatively treated by the current endoscopic mo dalities.