The Korean Journal of Gastroenterology :eISSN 2233-6869 / pISSN 1598-9992

 

Table. 3.

Summary and Strength of Recommendations for Early Gastric Cancer

Statement G1: We recommend chromoendoscopy/image-enhanced endoscopy to determine the extent of lesion before endoscopic treatment of early gastric cancer (Grade of recommendation: strong, Level of evidence: moderate).
Statement G2: Endoscopic ultrasonography before endoscopic resection of early gastric cancer may be helpful in determining the depth of invasion in some patients with early gastric cancer (Grade of recommendation: weak, Level of evidence: moderate).
Statement G3: We recommend endoscopic resection for early gastric cancer of well or moderately differentiated tubular or papillary adenocarcinoma meeting endoscopically estimated tumor size ≤2 cm and endoscopically suspected mucosal cancer without ulcer (Grade of recommendation: strong, Level of evidence: moderate).
Statement G4: We suggest endoscopic resection for early gastric cancer of well or moderately differentiated tubular or papillary adenocarcinoma meeting the following endoscopic findings: 1) mucosal cancer >;2 cm without ulcer, or 2) mucosal cancer ≤3 cm with ulcer (Grade of recommendation: weak, Level of evidence: moderate).
Statement G5: We suggest endoscopic resection for poorly differentiated tubular adenocarcinoma, poorly cohesive carcinoma, and signet ring cell carcinoma meeting the following endoscopic findings: endoscopically estimated tumor size ≤2 cm, endoscopically mucosal cancer, and no ulcer in the tumor (Grade of recommendation: weak, Level of evidence: low).
Statement G6: We recommend prophylactic hemostasis of visible vessels on the post-resection ulcer caused by endoscopic resection of early gastric cancer to lower the risk of delayed bleeding (Grade of ecommendation: strong, Level of evidence: low).
Statement G7: We recommend proton pump inhibitors to decrease the risk of symptoms and complications associated with iatrogenic ulcers caused by endoscopic resection of early gastric cancer (Grade of recommendation: strong, Level of evidence: high).
Statement G8: We recommend endoscopic closure as the first treatment option for perforation that occurred during endoscopic resection of early gastric cancer (Grade of recommendation: strong, Level of evidence: low).
Statement G9: We recommend surgical gastrectomy if histopathological evaluation after endoscopic resection of early gastric cancer meets the criteria for non-curative resection. An exception applies if cancer invasion is observed at the horizontal resection margin only (Grade of recommendation: strong, Level of evidence: moderate).
Statement G10: We recommend additional endoscopic management rather than surgical gastrectomy if histopathological evaluation of endoscopically resected early gastric cancer specimen shows positive involvement at the horizontal resection margin without any other findings compatible with non-curative resection (Grade of recommendation: strong, Level of evidence: moderate).
Statement G11: We recommend Helicobacter pylori eradication treatment after endoscopic resection of early gastric cancer in H. pylori-infected patients (Grade of recommendation: strong, Level of evidence: high).
Statement G12: We recommend regular surveillance endoscopy every 6-12 months for patients who have had curative endoscopic resection of early gastric cancer based on absolute or expanded criteria for early detection of metachronous gastric cancer (Grade of recommendation: strong, Level of evidence: low).
Statement G13: We suggest regular abdominopelvic CT scan of 6-12 month interval for detection of extra-gastric recurrence after curative endoscopic resection of early gastric cancer based on absolute and expanded criteria (Grade of recommendation: weak, Level of evidence: low).
Korean J Gastroenterol 2020;75:264~291 https://doi.org/10.4166/kjg.2020.75.5.264
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