Usefulness of Endoscopic Ultrasonography in Determining the Depth of Invasion and Indication for Endoscopic Treatment of Early Gastric Cancer

Introduction: Endoscopic ultrasonography (EUS) is a useful method for visualizing features of gastric cancer. However, a previously reported classification system tended to result in overstaging. We investigated the usefulness of EUS for evaluation of the depth of gastric cancer invasion and indications for endoscopic treatment. Methods: Accuracy of EUS for determining the depth of invasion and incidences of a positive basal margin were assessed in 235 patients who underwent endoscopic treatment or surgery for gastric cancer. The EUS-determined depth of invasion was classified its follows: EUS-M (lesion confined to sonographic layers 1 and 2); EUS-M/SM border (lesion with changes in sonographic layer 3 but no deeper than 1 min); EUS-SM (lesion with changes in sonographic layer 3 deeper than 1 mm); or EUS-AD (lesion with changes in sonographic layer 4 or 5). Results: Accuracy of EUS for determining the depth of invasion was as follows: EUS-M, 99% were M and SM1 lesions; EUS-M/SM border, 87% were M and SM1 lesions; EUS-SM, 91% were SM2 lesions; EUS-AD, 100% were muscularis propria or deeper lesions. There was no EUS-M or EUS-M/SM border lesion for which endoscopic treatment resulted in it positive basal margin. Conclusions: EUS is useful for accurately determining the depth of invasion of gastric cancer. When there are no endoscopically determined ulcerous changes. endoscopic treatment should be considered for EUS-M and EUS-M/SM border lesions, and EUS-SM lesions should be treated surgically