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[Gastric cancer 849. Ulcer finding]

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Selection of ESD candidate is very tricky. The most unclear part is ulcer or ulcer findings.

In the following case, there was a definite ulcer in the initial endoscopy. In the follow-up endoscopy, ulcer crator was filled with irregular tissue, but there were subtle fold changes. The histology was moderately differentiated adenocarcinoma. What's your recommendation, ESD or surgery?

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Because of the definite ulcer in the first endoscopy and the subtle ulcer finding in the follow up endoscopy, I recommended surgery. Final pathology was as followings;

Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.0x1.2 cm
6. Depth of invasion : invades submucosa (sm1) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 4.5 cm
8. Lymph node metastasis : no metastasis in 42 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N0



© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2020-3-30)