Endoscopic Submucosal Dissection (ESD) for Early Gastric Cancer (EGC) with Ten Year Follow up

Abstract

Gastric cancer is the fourth leading cause of cancer-related death worldwide. Early gastric cancer (EGC) is defined as cancer confined to the mucosa or superficial submucosa without any lymph node involvement. It carries a low risk of lymph node metastasis and can be eligible for endoscopic removal. Endoscopic submucosal dissection (ESD) is a minimally invasive, stomach-preserving treatment option for patients with EGC with long-term favorable outcomes. This report presents a 64-year-old female with a 20-pack-year smoking history and a medical history of EGC. She was diagnosed with EGC ten years ago, and an ESD was performed at that time. Her recent ten year follow up surveillance evaluation did not show any recurrence of her cancer, demonstrating that long term cancer free survival is possible in EGC with ESD alone. ESD is considered first-line therapy for select cases of EGC due to its ability to achieve en bloc resection, allow accurate histopathologic staging, and preserve gastric anatomy. Compared to gastrectomy, ESD is associated with significantly lower morbidity, and much improved quality of life. In appropriately selected patients, survival rates post-ESD often exceed 90%. This case demonstrates a patient who underwent ESD for EGC and at her current evaluation was found to be cancer-free after 10 years. This case further emphasizes the existing evidence that ESD offers oncologic outcomes comparable to surgical resection and helps mitigate the risks and long-term nutritional complications associated with gastrectomy and offers much better quality of life.

Keywords: Gastric cancer, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), endoscopic ultrasound (EUS), gastrectomy.