Early Gastric Cancer: When Can Endoscopy Alone Be Curative? (2026 Update)

For early gastric cancer that is confined to the mucosa, small in size, well differentiated, and free of ulceration, treatment can sometimes be completed with endoscopic submucosal dissection (ESD) alone, removing only the lesion. Since the stomach itself is not removed, eating habits and daily life remain largely unchanged.

Key Takeaways

• For early gastric cancer confined to the mucosa that meets size, differentiation, and ulcer-status criteria, endoscopic submucosal dissection (ESD) alone may be sufficient to complete treatment.
• If the removed tissue is examined under a microscope afterward and falls outside the criteria, the case may move on to additional surgery.
• Korea's 5-year relative survival rate for stomach cancer is 78.6% (National Cancer Registration Statistics, 2019–2023); this is a nationwide aggregate figure, not the outcome of any specific procedure or institution.
• Korea's national screening program includes stomach endoscopy every two years starting at age 40, which is known to contribute to a relatively high rate of early-stage detection.
• After ESD, patients typically fast for a day or two while being monitored for bleeding or perforation before being discharged.

What conditions make endoscopy-only treatment possible?

• Early gastric cancer that is small, well differentiated, and without ulceration is a candidate for endoscopic resection.
• Early gastric cancer refers to cancer confined to the mucosal layer of the stomach wall; in TNM staging terms, this corresponds to stage 1, where invasion is limited to the superficial layer and lymph node involvement is absent or minimal.
• When deciding on endoscopic resection, endoscopic ultrasound is used in addition to CT to more precisely assess invasion depth, and diagnostic laparoscopy may be performed if peritoneal spread is suspected.
• ESD is a procedure routinely performed in the gastroenterology departments of tertiary hospitals in Korea.

Can patients move on to surgery after endoscopic resection?

• Yes. After the tissue removed via ESD is examined under a microscope, if the invasion depth or resection margin status falls outside the established criteria, the case may proceed to additional gastrectomy.
• This differs from stage 2–3 disease (where the cancer has invaded deeply into the stomach wall or spread to lymph nodes), which requires surgery from the outset. In such more advanced cases, subtotal or total gastrectomy with lymph node dissection becomes the standard treatment.
• Even though the term 'early gastric cancer' is used in both situations, whether treatment ends with endoscopic resection or proceeds to surgery depends on the actual invasion depth and pathology findings, which is why accurate staging is the essential first step.

How do recovery and daily life differ after endoscopic resection?

• Because the stomach itself is not removed, patients can generally return to eating and living as before once treatment is complete — this is the biggest difference from surgery.
• After the procedure, patients typically fast for a day or two and are discharged once bleeding or perforation has been ruled out.
• By contrast, after gastrectomy, incision pain, bloating sensations, and dietary adjustment are common, and patients must learn to eat smaller, more frequent meals since overall intake per sitting decreases.
• For patients who underwent endoscopic resection, the interval of follow-up endoscopy is especially important, since it is used to check for new lesions developing in the remaining stomach.

FAQ — What happens if the pathology results are unfavorable?

If the invasion depth or resection margin status of the tissue removed via ESD falls outside the criteria, additional surgery may be necessary. This determination is made after the microscopic pathology results come back, and if surgery becomes necessary, gastrectomy with lymph node dissection becomes the standard treatment.

FAQ — Would robotic or laparoscopic surgery also be considered?

If early gastric cancer falls outside the criteria for endoscopic resection and surgery becomes necessary, the choice among open, laparoscopic, and robotic approaches is made based on tumor location and stage. Laparoscopic and robotic approaches tend to involve less pain and smaller scars, allowing for faster recovery, but which approach is appropriate depends on the stage and location of the tumor.

Sources and Notes

• This article was written based on the National Cancer Registration Statistics 2019–2023 (Korea Central Cancer Registry, National Cancer Center), the National Cancer Information Center, and stomach cancer information from the NCCN patient guidelines.
• This content is intended for general medical information purposes only. Diagnosis, treatment methods, and outcomes may vary depending on individual circumstances. Accurate diagnosis and treatment decisions should always be made in consultation with a healthcare provider.