History and future perspectives in Japanese guidelines for endoscopic resection of early gastric cancer

Japanese guidelines for gastric cancer treatment were first published in 2001 for the purpose of showing the appropriate indication for each treatment method, thereby reducing differences in the therapeutic approach among institutions, and so on. With the accumulation of evidence and the development and prevalence of endoscopic submucosal dissection (ESD), the criteria for the indication and curability of endoscopic resection (ER) for early gastric cancer (EGC) have expanded. However, several problems still remain. Although a risk‐scoring system (eCura system) for predicting lymph node metastasis (LNM) may help treatment decision in patients who do not meet the curative criteria for ER of EGC, which is referred to as eCura C‐2 in the latest guidelines, additional gastrectomy with lymphadenectomy may be excessive for many patients, even those at high risk for LNM. Less‐invasive function‐preserving surgery, such as non‐exposed endoscopic wall‐inversion surgery with laparoscopic sentinel node sampling, may overcome this problem. In addition, further less‐invasive treatment, such as ER with chemotherapy, should be established for patients who prefer not to undergo additional gastrectomy.