Endoscopic treatment of early gastric cancer in Japan

Endoscopic treatment of early gastric cancer (EGC) mainly divided into polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). The former two are applied to a limited number of small cases and the latter to the rest of cases. Data from national insurance database released by the Ministry of Health, Labour and Welfare revealed that 43, 294, and 3251 EGCs were treated by polypectomy, EMR, and ESD, respectively, in June 2012, whereas gastrectomy was performed in 4722 cases including advanced gastric cancer. So ESD is a central role of treatment for EGC in Japan. The outcomes of gastric ESD are considered to be more than 95% of en bloc resection rates, around 5% of intraoperative perforation rates, and around 5% of postoperative bleeding rates. In cases of curative resection with traditional criteria and expanded criteria, the five year survival rates were reported to be 92.4% and 93.4%, respectively(Br J Surg 97:868-871,2010). In February 2014, we published the ESD/EMR guidelines for gastric cancer(Gastroenterol Endosc 56:309-323,2014). We made sections of indication, preoperative diagnosis, methods, evaluation of curability, complications, follow-up, and pathological managements and 23 statements were described with evidence levels and recommendation grades. However, it must be big problems that there is no evidence with a higher level. Our Japanese endoscopists must make well designed clinical trials as pioneers of gastric endoscopic treatments, although some of them are ongoing.