This protocol covers the management of very early gastric cancer at stage IA where the tumour is confirmed to be restricted to the innermost layer of the stomach wall — a specific presentation that qualifies for a distinct, less invasive treatment strategy.
The tumour is confined to the gastric mucosa (T1a), is well-differentiated (grade G1–2), measures 2 cm or smaller, and is non-ulcerated — meeting each of the four criteria that define suitability for endoscopic management.
For this carefully defined early presentation, endoscopic resection is the recommended first approach, carried out with the aim of complete removal in a single piece. Two endoscopic techniques are available in clinical practice, with selection depending on lesion size and histological risk — the criteria governing which technique is preferred, and the role of surgical resection as an alternative, are detailed in the full protocol.
Full technique selection criteria, resection standards, and clinical decision algorithm available via the link below.DOI: 10.1016/j.annonc.2022.07.004
Endoscopic resection is recommended for very early gastric cancers (T1a) if they are clearly (i) confined to the mucosa, (ii) well-differentiated G1-2, (iii) 2 cm and (iv) non-ulcerated.
Two forms of endoscopic resection are used in clinical practice: EMR is acceptable for lesions smaller than 10-15 mm with a very low probability of advanced histology (Paris 0-IIa); however, the European Society of Gastrointestinal Endoscopy (ESGE) recommends ESD as the treatment of choice for most gastric superficial neoplastic lesions.
Endoscopic resection of early gastric cancer should be carried out en bloc and allow for a complete histological evaluation of the lateral and basal resection margins.
Endoscopic or surgical resection alone is appropriate for selected very early tumours (stage IA) [III, B].
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