ASGE-JGES Endoscopic Submucosal Dissection ESD (On-demand) | October 2025-Takizawa

Takizawa_Esophageal SCC and Gastric Cancer

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This presentation by Dr. Kohei Takizawa from Kanagawa Cancer Center focuses on the indications and procedural evaluation for upper gastrointestinal (GI) endoscopic submucosal dissection (ESD), covering gastric cancer, esophageal squamous cell carcinoma (SCC), and Barrett's esophageal cancer.<br /><br />For gastric cancer, ESD is indicated primarily for early-stage tumors confined to the mucosa (cT1a), with size and ulceration status determining absolute or relative indications based on differentiation status. The "eCura" system is used to assess curability post-ESD, categorizing patients into eCura A (curative), C-2 (non-curative), etc., based on pathological findings such as depth of invasion, lymphovascular involvement, ulceration, and margin status. The eCura scoring system also predicts 5-year disease-specific survival (DSS) and lymph node metastasis (LNM) risk for cases not meeting curative criteria, helping guide patient management decisions between follow-up versus additional surgery.<br /><br />Esophageal SCC is evaluated using the Japan Esophageal Society (JES) classification based on microvascular patterns observed endoscopically (IPCL classification), differentiating tumor depth into EP-LPM, MM-SM1, and SM2 or deeper invasion using loop and non-loop vessel morphologies. These classifications assist in predicting invasion depth and suitable candidates for ESD.<br /><br />Case examples illustrate diagnostic processes, pathology results, and curability assessments. For instance, an early gastric cancer lesion (tubular adenocarcinoma, intramucosal) with favorable pathology achieved eCura A status, while a submucosal invasive lesion was non-curative, requiring consideration of additional treatment. Similarly, an esophageal SCC case with superficial invasion was found non-curative pathologically.<br /><br />In conclusion, accurate endoscopic diagnosis based on lesion characteristics, histology, and vessel pattern classification is crucial for selecting appropriate upper GI cancers for ESD. The eCura system provides prognostic stratification post-procedure to inform further treatment and surveillance strategies.<br /><br />Contact: koh.takizawa@gmail.com

Keywords

Upper gastrointestinal endoscopy

Endoscopic submucosal dissection (ESD)

Gastric cancer

Esophageal squamous cell carcinoma (SCC)

Barrett's esophageal cancer

eCura scoring system

Japan Esophageal Society (JES) classification

Microvascular pattern (IPCL)

Curability assessment

Lymph node metastasis risk