Surgical endoscopy · 2026
Feasibility and safety of cap-assisted endoscopic mucosal resection compared with endoscopic submucosal dissection for gastric adenocarcinoma of the fundic gland type.
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Kano Yuki, Yamazaki Hiroshi, Sawada Takashi, Miyauchi Hideyuki, Kohari Keisuke, Kurebayashi Hosyu, Sawada Rikimaru, Sato Yu, Kanamori Myuzen, Iida Toshifumi, Banjoya Susumu, Kimura Tomoya, Furuta Koichi, Takeuchi Nao, Kimoto Yoshiaki, Ono Kohei, Minato Yohei, Sakai Eiji, Chiba Hideyuki, Asai Satoshi, Ohata Ken
Аннотация
BACKGROUND AND AIM: Gastric adenocarcinoma of the fundic gland type (GA-FG) is a rare gastric cancer subtype, usually located in the upper stomach and accompanied by submucosal invasion. Although endoscopic submucosal dissection (ESD) is the standard treatment, it is challenging in this location. Cap-assisted endoscopic mucosal resection (EMRC) may represent a simpler alternative; however, its efficacy and safety for GA-FG remain unclear. We therefore assessed the feasibility, safety, and histological resection depth of EMRC for GA-FG, vs. ESD.
METHODS: This single-center retrospective study included consecutive patients with histologically confirmed GA-FG measuring < 10 mm. They underwent ESD between August 2013 and February 2023 or EMRC between February 2023 and July 2025. Clinical outcomes, pathological findings, and delayed adverse events were compared. The distance from the muscularis mucosae to the deepest resection margin and the proportion of submucosal tissue in the resected specimens were also evaluated in the EMRC group.
RESULTS: We analyzed 94 lesions (ESD: n = 54, EMRC: n = 40). En bloc resection was achieved in all cases. The median procedure time was significantly longer for ESD vs. EMRC (25.0 vs. 6.0 min, P < 0.01), as was hospitalization length (7.0 vs. 5.0 days, P < 0.01). There were no significant differences between the groups regarding vertical margin status or adverse events. All EMRC specimens contained submucosal tissue, with a median resection depth of 817.5 μm (interquartile range 526.6-1768.4). Treatment modality was determined according to the treatment period (ESD before February 2023 and EMRC thereafter), which may have introduced temporal and selection bias.
CONCLUSIONS: For GA-FG lesions measuring < 10 mm, EMRC appears to be a promising treatment option, providing adequate submucosal resection depth while reducing procedure and hospitalization time.
METHODS: This single-center retrospective study included consecutive patients with histologically confirmed GA-FG measuring < 10 mm. They underwent ESD between August 2013 and February 2023 or EMRC between February 2023 and July 2025. Clinical outcomes, pathological findings, and delayed adverse events were compared. The distance from the muscularis mucosae to the deepest resection margin and the proportion of submucosal tissue in the resected specimens were also evaluated in the EMRC group.
RESULTS: We analyzed 94 lesions (ESD: n = 54, EMRC: n = 40). En bloc resection was achieved in all cases. The median procedure time was significantly longer for ESD vs. EMRC (25.0 vs. 6.0 min, P < 0.01), as was hospitalization length (7.0 vs. 5.0 days, P < 0.01). There were no significant differences between the groups regarding vertical margin status or adverse events. All EMRC specimens contained submucosal tissue, with a median resection depth of 817.5 μm (interquartile range 526.6-1768.4). Treatment modality was determined according to the treatment period (ESD before February 2023 and EMRC thereafter), which may have introduced temporal and selection bias.
CONCLUSIONS: For GA-FG lesions measuring < 10 mm, EMRC appears to be a promising treatment option, providing adequate submucosal resection depth while reducing procedure and hospitalization time.