Exploring the possibility of endoscopic submucosal dissection for clinical submucosal invasive early gastric cancers

  • Hyun Deok Lee
  • Hyunsoo ChungEmail author
  • Sang Gyun Kim
  • Jung Kim
  • Jue Lie Kim
  • Eunwoo Lee
  • Hyun Chae Jung



The current standard treatment modality for clinical submucosal invasive (cT1b) early gastric cancer (EGC) is surgery. However, there are discrepancies in T staging between pre- and post-operative findings, and in cases of overestimation, patients may lose the opportunity to preserve the stomach. The aim of this study was to analyze surgical outcomes of cT1b EGC and determine the pre-treatment factors favoring ESD.


Patients who underwent gastrectomy for cT1b EGC with a tumor size of 30 mm or less in diameter and differentiated-type histology were retrospectively reviewed from January 2010 to December 2014. According to the final surgical pathologic results, two groups were classified: patients whose pathologic results qualified for current ESD indication (ESD-qualified group, n = 203) and patients whose pathologic results made them ineligible for ESD (ESD-disqualified group, n = 261). The preoperative clinical characteristics were compared.


Forty-three percent of the patients (203/464) who underwent gastrectomy for cT1b EGC qualified for ESD; their endoscopic lesion tended to be smaller than 20 mm in size and located in the distal part of stomach. In addition, the ESD-qualified group showed a significantly higher proportion of well-differentiated tubular adenocarcinoma on endoscopic biopsy and of the flat/depressed type in the endoscopic evaluation.


Forty-three percent of the patients with cT1b EGC who underwent gastrectomy had a chance to preserve their stomach by ESD. Therefore, pre-treatment factors such as endoscopic lesion size, location, histology, and gross type should be considered for treatment modality selection for cT1b EGC.


Clinical submucosal invasive early gastric cancer Endoscopic submucosal dissection Pre-treatment factors 


Compliance with ethical standards


Hyun Deok Lee, Hyunsoo Chung, Sang Gyun Kim, Jung Kim, Jue Lie Kim, Eunwoo Lee, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea

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