Twenty-nine cases of early gastric cancer were treated endoscopically by Nd-YAG laser irradiation and combination with endoscopic mucosal resection therapy. The cases indicated because of high risk for surgery were as followed; one lesion of type I eary gastric cancer, 8 lesions of type IIa, 17 lesions of type IIc, 3 lesions of type IIa+IIc.
7 lesions of the protruted type, I, IIa, and one lesion of depressed type, IIc were underwent combination therapy procedures. The lesion has disappeared in 7 out of 8 lesions. Local relapse occured in 1 case because of invasion into submucosal layer.
5 lesions of protruted type, IIa, IIa+IIc, and 16 lesions of depressed type, IIc were treated by Nd-YAG laser irradiation. 15 out of 19 lesions were destroied by laser therapy only, but local relapse was observed in 4 patients, in whom poorly differentiated adenocarcinoma and submucosal invasions were noticed. In such a high risk patients, we tried local injection of immuno-activating agent (ok-432) by endoscopically. 2 lesions, which were over 2 cm in diameter and submucosal invasions were treated. These patients were followed for 18 months, no relapse was occured until now. Among other early gastric cancers, endoscopic treatment is indicated for differentiated adenocarcinoma which are less than 2 cm in size and confined with the mucosal layer.
