Endoscopic submucosal resection (ESR) has become a widely accepted treatment modality for the management of early-stage gastric cancer, particularly for patients who are not eligible for surgery due to various reasons such as advanced age or comorbidities. The aim of this article is to review the effectiveness of ESR in the management of initial cancer.

ESR Procedure

The ESR technique involves the resection of the tumor along with the submucosa layer of the gastric mucosa. The procedure is usually carried out under general anesthesia, using an endoscope fitted with a snare device.

The snare is used to capture the tumor and the submucosa layer is lifted using a saline solution or carbon dioxide. After the tumor is cut, the base is coagulated using an electrocautery instrument. The tumor specimen is then sent for histological analysis.

Effectiveness of ESR

ESR is considered an effective treatment option for early-stage gastric cancer. The curative resection rate of ESR for early-stage gastric cancer has been reported to be as high as 95% in some studies.

Furthermore, the 5-year survival rate of patients who undergo ESR is similar to that of patients who undergo surgery. Therefore, ESR is considered a feasible alternative to surgery for the management of early-stage gastric cancer.

Indications for ESR

The indications for ESR are primarily based on the size, location, and depth of invasion of the tumor.

ESR is most effective for tumors that are less than 2 cm in size, located in the stomach without any lymph node metastasis, and have not penetrated beyond the submucosal layer. Patients who have a high risk of surgical complications, advanced age, comorbidities, or refuse surgery are also considered suitable candidates for ESR.

Complications of ESR

ESR is generally considered to be a safe and effective procedure, with a low incidence of complications. However, complications may occur, including bleeding, perforation, and recurrence.

The incidence of bleeding is less than 5%, and can usually be managed with endoscopic hemostasis. Perforation is rare, occurring in less than 1% of cases, and can usually be treated with endoscopic clipping or surgery. Recurrence rates vary depending on the size, location, and depth of invasion of the tumor, and can range from 1% to 30%.

Follow-up after ESR

Patients who undergo ESR require regular follow-up to monitor for recurrence. Follow-up endoscopy, imaging studies, and biopsy are recommended at regular intervals.

Post-ESR surveillance intervals should be customized to the patient’s individual risk of recurrence, according to the Japanese Gastric Cancer Association guidelines. Patients with a low risk of recurrence require follow-up at intervals of 12 months for 3 years, while high-risk patients require more frequent follow-up.

Conclusion

Endoscopic submucosal resection is an effective treatment option for early-stage gastric cancer, with high rates of curative resection and survival rates comparable to those of surgery.

ESR is considered a feasible alternative to surgery for patients who are not eligible for surgery due to various reasons such as advanced age or comorbidities. Complication rates are low, and patients require regular follow-up to monitor for recurrence.