This protocol covers a specific, defined subgroup of early gastric cancer: tumors with poorly differentiated tubular or poorly cohesive histology — including signet-ring cell type — confirmed on endoscopy to be confined to the mucosa, with no ulcer and estimated size no greater than 2 cm.
All of the following endoscopic findings must be present for this protocol to apply:
For tumors meeting the above endoscopic criteria, an endoscopic resection approach may be cautiously considered following thorough clinical discussion. Standard surgical intervention also remains an option for eligible cases.
The complete decision criteria, management algorithm, and full evidence base are available in the structured protocol below.
DOI: 10.5230/jgc.2025.25.e11
Endoscopic resection could be cautiously considered for poorly differentiated tubular or poorly cohesive (including signet-ring cell) EGCs meeting the following endoscopic findings after sufficient discussion: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor.
Therefore, standard surgery (gastrectomy with LN dissection) can also be considered for cases meeting these criteria.