ENDOSCOPIC RESECTION FOR EARLY GASTRIC CANCER: EVOLUTION OF EXPANDED INDICATIONS AND FUTURE CHALLENGES

Abstract

Endoscopic resection for early gastric cancer (EGC) has advanced substantially since the introduction of ESD in the early 2000s, driven by technological innovations and increased procedural expertise. This progress facilitated a gradual expansion of therapeutic indications. Evidence has accumulated via prospective multicenter studies, such as JCOG0607, JCOG1009/1010, and J-WEB/EGC, and the eCura system has been widely implemented for postoperative risk stratification of lymph node metastasis and recurrence. Considering rapid population aging, reassessing treatment indications and curability criteria in elderly patients is crucial to maximize the benefits of minimally invasive endoscopic therapy. Furthermore, treatment decisions should incorporate patient-related factors, including physical and cognitive function, and the values of patients and their families, along with consideration of cost-effectiveness. Developing an individualized, multidimensional framework for treatment selection is a key challenge and future direction in EGC management.