Cutting-edge Endoscopic Diagnosis and Treatment for Early Gastric Cancer

Duneo Geesher^*
*Correspondence: Duneo Geesher, Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, Email:

Introduction

Early Gastric Cancer (EGC) presents a unique challenge due to its subtle symptoms and potential for rapid progression. Endoscopic techniques have evolved significantly, offering precise diagnostic capabilities and minimally invasive therapeutic interventions. This review explores the current advancements in endoscopic diagnosis and treatment strategies for EGC, focusing on their efficacy, safety, and implications for clinical practice. Early detection of gastric cancer remains pivotal for improving patient outcomes, particularly as the prognosis drastically improves with early intervention. Traditional diagnostic modalities such as endoscopy with biopsy have been cornerstone approaches, but recent innovations have propelled the field towards more sophisticated and precise methods. This article discusses the evolution of endoscopic technologies and their impact on the management of EGC.

Modern endoscopic techniques such as high-definition endoscopy, Narrow-Band Imaging (NBI), and magnification endoscopy have revolutionized the detection and characterization of early gastric lesions. NBI, in particular, enhances the visualization of mucosal patterns and vascular structures, aiding in the differentiation between benign and malignant lesions. Additionally, the advent of advanced imaging modalities like Confocal Laser Endomicroscopy (CLE) provides real-time microscopic assessment, further refining diagnostic accuracy. Early detection of gastric cancer is crucial for improving patient outcomes and prognosis. Traditional diagnostic methods like white-light endoscopy with biopsy have been pivotal in identifying suspicious lesions. However, advancements in endoscopic technology have significantly enhanced the precision and reliability of diagnosing Early Gastric Cancer (EGC) [1].

Description

High-definition endoscopy provides superior image resolution compared to standard definition, enabling endoscopists to visualize subtle mucosal changes and abnormalities more clearly. This improved visualization aids in the early detection of lesions that may be missed with conventional endoscopy. Narrow-band imaging utilizes specific wavelengths of light to enhance the contrast of superficial mucosal structures and vascular patterns. This technology facilitates the differentiation between dysplastic and nondysplastic lesions based on their vascular architecture and mucosal patterns. Studies have demonstrated that NBI increases the detection rate of early gastric neoplasms and improves diagnostic accuracy compared to traditional methods. Magnification endoscopy allows for detailed examination of mucosal features at a microscopic level. By magnifying the image, endoscopists can assess cellular and structural changes indicative of malignancy or dysplasia. This technique is particularly useful in evaluating subtle changes in the mucosa and determining the extent of lesions during diagnostic procedures [1,2].

Beyond traditional endoscopy, advanced imaging modalities such as Confocal Laser Endomicroscopy (CLE) offer real-time, high-resolution imaging of cellular structures within the mucosal layer. CLE enables in vivo microscopic examination, providing immediate histological information during endoscopic procedures. This capability enhances the accuracy of diagnosing early gastric lesions and helps guide treatment decisions. Virtual chromo endoscopy techniques, such as Flexible Spectral Imaging Color Enhancement (FICE) and i-Scan, simulate the effect of dye spraying without the need for actual dye administration. These modalities enhance the visualization of mucosal details and subtle lesions by digitally enhancing specific color contrasts, thereby improving lesion detection rates and diagnostic precision.

The integration of artificial intelligence and machine learning algorithms is revolutionizing endoscopic diagnostics. AI-based systems can analyze endoscopic images in real-time, assisting endoscopists in identifying suspicious lesions, predicting histological outcomes, and improving diagnostic accuracy [3]. These systems are continuously evolving to refine their capabilities and expand their utility in clinical practice. Combining various advanced imaging technologies, such as NBI with magnification or CLE with virtual chromo endoscopy, further enhances the diagnostic yield and accuracy of detecting early gastric cancer. These combined approaches leverage the strengths of each modality to provide comprehensive mucosal assessment and improve lesion characterization.

Endoscopic treatment options for EGC have expanded beyond mere diagnosis to include curative intent therapies. Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) have emerged as standard techniques for the removal of early-stage lesions, offering comparable outcomes to surgical resection while minimizing morbidity and preserving gastric function. Moreover, advancements in endoscopic suturing techniques and closure devices have improved the safety and feasibility of complex resections. The adoption of advanced endoscopic interventions in clinical practice has led to favorable outcomes in terms of oncological efficacy and patient satisfaction. Studies demonstrate high rates of complete resection and low recurrence rates in appropriately selected patients. However, challenges persist, including the management of adverse events such as bleeding and perforation, as well as the optimal selection criteria for endoscopic versus surgical approaches [3,4].

Future research directions aim to refine risk stratification models and develop predictive biomarkers to personalize treatment strategies further. The integration of Artificial Intelligence (AI) and machine learning algorithms holds promise in enhancing diagnostic accuracy and procedural outcomes. Additionally, ongoing studies explore novel endoscopic techniques, such as Endoscopic Full-Thickness Resection (EFTR) and photodynamic therapy, to expand the therapeutic armamentarium for EGC. Endoscopic mucosal resection involves the removal of superficial lesions by lifting and snaring the mucosa using an endoscopic device. EMR is suitable for lesions confined to the mucosal layer (T1a) and offers advantages such as minimal invasiveness, shorter hospital stays, and rapid recovery compared to surgical resection. Various techniques within EMR, such as cap-assisted EMR and ligationassisted EMR, have been developed to improve the completeness of resection and reduce procedural risks.

Endoscopic submucosal dissection is an advanced technique that allows for en bloc resection of larger or more complex lesions involving the submucosal layer. ESD uses specialized knives and devices to dissect and remove the lesion meticulously while preserving the integrity of the surrounding tissue layers. This technique is associated with higher rates of complete resection and lower recurrence rates compared to EMR but requires advanced endoscopic skills and longer procedural times. In cases where lesions are more extensive or infiltrate deeper layers of the gastric wall, combined endoscopic therapies may be employed. This includes techniques such as endoscopic mucosal resection followed by ablation therapy (e.g., thermal ablation or cryotherapy) to eradicate residual neoplastic tissue and reduce the risk of recurrence. Combined therapies aim to achieve comprehensive eradication of the lesion while minimizing the need for surgical intervention [4].

Endoscopic full-thickness resection is a newer technique that allows for the removal of lesions involving the full thickness of the gastric wall. EFTR techniques utilize specialized devices, such as full-thickness resection devices and closure devices, to achieve complete resection while ensuring effective closure of the gastric defect. EFTR is particularly useful for lesions located in challenging anatomical locations or those requiring complete removal for oncological clearance. Advances in endoscopic closure devices, including OTSCs and through-the-scope clips, have improved the safety and efficacy of complex endoscopic procedures. These devices enable secure closure of mucosal and submucosal defects created during resection, reducing the risk of post-procedural complications such as bleeding and perforation. Enhanced closure techniques have expanded the feasibility of performing larger and more complex endoscopic resections with improved patient outcomes.

Following endoscopic resection, adjuvant therapies such as endoscopic Radiofrequency Ablation (RFA) or Photodynamic Therapy (PDT) may be employed to treat residual or recurrent lesions and prevent disease progression. Moreover, rigorous post-procedural surveillance protocols involving endoscopic follow-up and imaging studies are essential to detect early recurrence and ensure long-term oncological control. Comparative studies evaluating the effectiveness and outcomes of different endoscopic treatment modalities (e.g., EMR vs. ESD) have demonstrated comparable oncological outcomes to surgical resection in selected cases of early gastric cancer. These studies highlight the importance of personalized treatment approaches based on lesion characteristics, patient factors, and institutional expertise [5].

Conclusion

In conclusion, cutting-edge endoscopic techniques have transformed the management paradigm for early gastric cancer, offering precise diagnostic capabilities and minimally invasive therapeutic options. As technology continues to advance, integrating these innovations into clinical practice promises to further improve patient outcomes and redefine the standard of care for EGC.

Acknowledgement

None.

Conflict of Interest

Authors declare no conflict of interest.

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