Endoscopy is mandatory to detect early gastric cancer (EGC). When considering the cost-effectiveness of the endoscopic screening of EGC, risk stratification by combining serum pepsinogen values and anti-H. pyloriIgG antibody values is very promising. After the detection of suspicious lesions of EGC, a detailed observation using magnifying endoscopy with band-limited light is necessary, which reveals an irregular microsurface and/or an irregular microvascular pattern with demarcation lines in the case of cancerous lesions. Endocytoscopy enables us to make an in vivo histological diagnosis. In terms of the indications for endoscopic resection, the likelihood of lymph node metastasis and technical difficulties in en bloc resection is considered, and they are divided into absolute, expanded, and relative indications. Endoscopic mucosal resection and endoscopic submucosal dissection are the main treatment modalities nowadays. After endoscopic resection, curability is evaluated histologically as endoscopic curability (eCura) A, B, and C (C-1 and C-2). Recent evidence suggests that the outcomes of endoscopic resection for many EGCs are comparable to those of gastrectomy and that endoscopic resection is the gold standard for node-negative early gastric cancers. Personalized medicine is also being developed to overcome the unmet needs in treatments of EGC, for example the further expansion of indications and newer resection techniques, such as full-thickness resection.
内镜检查是发现早期胃癌（EGC）的必要手段。在考虑EGC内镜筛查的成本效益时，结合血清胃蛋白酶原值和抗幽门螺杆菌IgG抗体值进行风险分层的方法极具前景。一旦发现可疑的EGC病变，需使用带限光放大内镜进行详细观察，癌性病变会显示出不规则的微表面和/或不规则的微血管模式，并伴有分界线。内镜细胞学检查使我们能够进行活体组织学诊断。关于内镜切除的适应症，需考虑淋巴结转移的可能性及整块切除的技术难度，并将其分为绝对适应症、扩大适应症和相对适应症。目前，内镜黏膜切除术和内镜黏膜下剥离术是主要的治疗方式。内镜切除后，根据组织学评估治愈性，分为内镜治愈性（eCura）A、B和C（C-1和C-2）等级。近期证据表明，对于许多EGC病例，内镜切除的效果与胃切除术相当，且内镜切除已成为无淋巴结转移早期胃癌的金标准治疗。为满足EGC治疗中尚未满足的需求，个性化医疗也在不断发展，例如进一步扩大适应症范围及开发新的切除技术，如全层切除术。
Advanced Diagnostic and Therapeutic Endoscopy for Early Gastric Cancer
肿瘤(癌症)患者之家