This protocol covers management of well or moderately differentiated tubular or papillary early gastric cancer (EGC) in patients whose lesion meets specific endoscopic criteria — a defined sub-population with distinct treatment pathways depending on resection outcomes.
Endoscopic resection is recommended for well or moderately differentiated tubular or papillary EGCs meeting all of the following endoscopic findings: estimated tumor size ≤2 cm, confirmed mucosal cancer endoscopically, and no ulcer present within the tumor. Gastric mucosal mass findings are central to assessment in this setting.
When endoscopic resection does not achieve curative criteria, additional surgical intervention targeting the stomach and regional lymph nodes is indicated. In select cases where only the resection margin meets a specific condition while all other curative criteria are satisfied, a targeted endoscopic procedure may be considered as an alternative to surgery.
DOI: 10.5230/jgc.2025.25.e11
Endoscopic resection is recommended for well or moderately differentiated tubular or papillary EGCs meeting the following endoscopic findings: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor.
Additional surgery is recommended when the results of endoscopic resection for EGC do not meet the criteria for curative resection or when lymphovascular invasion or positive vertical margin is present.
After endoscopic resection in EGC, endoscopic treatment such as ESD and APC could be considered for EGCs that have only positive lateral margins and meet all other criteria for curative resection.
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