Validity of Endoscopic Submucosal Dissection for Diffuse Type Early Gastric Cancer

As a safe and reliable treatment to intestinal type early gastric cancer, endoscopic submucosal dissection (ESD) is widely prevalent. On the other hand, ESD for diffuse type early gastric cancer is a controversial subject. The reasons are that the possibility of lymphatic and venous invasion is high in diffuse type and lymph node dissection is impossible in ESD. In Japan, we define diffuse type T1a cancer smaller than 20mm in diameter without ulceration and lymphatic and venous invasion as the expanded indication for ESD and we have performed ESD for such lesions with careful supervision. We examined the validity of ESD for the expanded indications by verifying the lesions which performed operation or ESD in our hospital.