Abstract
Background and Study Aims: A recent challenge that is increasingly being faced in endoscopy is the use of endoscopic
mucosal resection (EMR) to treat differentiated intramucosal gastric cancers smaller
than 2 cm. The usefulness of pretherapeutic endoscopic ultrasonography (EUS) in assessing
whether this form of treatment is possible remains controversial.
Patients and Methods: We retrospectively investigated the value of pretherapeutic EUS evaluation in 58
patients with macroscopically early gastric cancer that was histologically differentiated
and less than 2 cm in diameter. The patients were classified as negative for endoscopic
mucosal resection if EUS showed modifications of the third layer, and as positive
if such modifications were not seen. All patients underwent radical surgery and the
preoperative EUS findings were compared with the histological findings.
Results: The prevalence of metastatic adenopathy was 3 % (two of 58). In the lymph-node staging,
endosonography had a sensitivity of 0 % (neither of two cases) and a specificity of
93 % (52 of 56). In assessing the indication for EMR, EUS had a sensitivity of 93 %
(27 of 29), and a specificity of 86 % (25 of 29).
Conclusions: These results suggest that EUS is a promising method of evaluating the indication
for endoscopic mucosal resection in early gastric cancer. EUS may improve pretherapeutic
prediction of tumor curability by EMR, and may reduce the need for standard gastrectomy.
