Early Gastric Cancer/Tumor · ESD vs Gastrectomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Differentiation/ulcer/size/depth → criteria
   Differentiated? Ulcer? Size? Depth of invasion? (Curative resection = en-bloc + negative margins + no lymphovascular invasion + depth limited to mucosa or sm1 (<500 µm, differentiated).)
   • Absolute criteria: differentiated, no ulcer, intramucosal, ≤2 cm → Absolute criteria → ESD
   • Expanded criteria (differentiated no ulcer any size / differentiated with ulcer ≤3 cm / undifferentiated no ulcer ≤2 cm / differentiated SM1 <500 µm ≤3 cm) → Expanded criteria → ESD
   • Beyond criteria: SM2 (≥500 µm)/poorly differentiated deep invasion/lymphovascular+/evident nodes → Beyond criteria → surgical gastrectomy
2. [End] Absolute criteria → ESD
   Absolute criteria → en-bloc ESD; confirm curative on pathology (negative margins, no lymphovascular invasion, depth limited to mucosa), with periodic endoscopic surveillance.
3. [End] Expanded criteria → ESD
   Expanded criteria → ESD (slightly higher but acceptable nodal-metastasis risk); ensure en-bloc resection and pathologic assessment of curative status; non-curative (margin+/lymphovascular+/SM2) → add surgery.
4. [End] Beyond criteria → surgical gastrectomy
   Beyond endoscopic criteria (SM2/poorly differentiated deep invasion/lymphovascular+/nodes) → surgical gastrectomy + regional lymphadenectomy (laparoscopic/open); high nodal-metastasis risk.

Source guidelines & references

• Endoscopic submucosal dissection criteria for early gastric cancer (AGA 2022; JGCA ESD criteria)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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