Endoscopic submucosal dissection for early gastric cancer: A review of comparative perspectives on treatment outcomes vs gastrectomy

Table 1 Comparison of key perioperative indicators between endoscopic submucosal dissection and conventional gastrectomy

Key performance indicators	ESD group	Conventional gastrectomy group	Statistical results	Conclusion
Overall treatment success rate	92.86%	Slightly lower	χ² = 2.293, P > 0.05	There was no statistically significant difference between the two groups
Incidence of complications	5.56%	13.27%	P < 0.05	The ESD group offers superior safety
Intraoperative blood loss	Less	More	-	The ESD group is superior
Duration of the operation	Shorter	Longer	-	The ESD group is superior
Recovery time after oral administration	2.43 days	Longer	-	The ESD group is superior

ESD: Endoscopic submucosal dissection.

Table 2 Assessment of the quality and limitations of the research evidence

Evaluation criteria	Features	Level of evidence
Research design	Single-centre retrospective cohort	Below average
Sample size	206 cases of early-stage gastric cancer	Intermediate
Follow-up interval	Short-term perioperative period; no long-term survival	The evidence is incomplete
Bias risk	Selection bias, baseline imbalance	Limited generalisability
Strength of the conclusion	Short-term benefits are certain, but long-term efficacy is uncertain	This requires validation through prospective studies

Table 3 Summary table of clinical studies on endoscopic submucosal dissection for early-stage gastric cancer

Research level	Type of research	Key findings	Ref.
Short-term efficacy and safety	Retrospective study	The short-term efficacy of the ESD group was comparable to that of the conventional surgery group, with no statistically significant difference in the overall response rate	Ling et al[15]
	Retrospective study	The ESD group demonstrated superior safety in terms of short-term efficacy	Hahn et al[33]
Long-term outcome	Multicentre prospective study	The 5-year OS rate for ESD is comparable to that of surgical gastrectomy	Takizawa et al[34]
	Propensity score matching retrospective study	The five-year recurrence-free survival rate for SR is superior to that of ESD, and it has a broader range of indications	Fukunaga et al[35], Lim et al[36]
	Integration of research data	SR shows no clear advantage, but patients with SR have a better 5-year disease-free survival than those with ESD in the expanded indication	Xu et al[37]
Prognosis and monitoring	Multicentre retrospective cohort study	The incidence of post-ESD synchronous cancer remains stable, and standardised monitoring allows for the management of almost all recurrent lesions	Kato et al[42]
	Related research	Complications associated with ESD are manageable, with a 5-year OS rate of 99.3% in specific patients (95%CI: 97.1%-99.8%)	Takizawa et al[34]
Summary		ESD is a minimally invasive, safe and effective treatment for early-stage gastric cancer, although some outcomes are inferior to those of surgical resection; synchronous or metachronous gastric cancer following the procedure affects prognosis and requires standardised endoscopic monitoring

ESD: Endoscopic submucosal dissection; OS: Overall survival; SR: Surgical resection.

Table 4 Comparison table of regional guidelines on indications for endoscopic submucosal dissection in early-stage gastric cancer by subtype (Korean Gastric Cancer Association/Japanese Society of Gastrointestinal Endoscopy/MAPS III)

Tumour classification and characteristics	South Korea (Korean Gastric Cancer Association 2024)	Japan (Japanese Society of Gastrointestinal Endoscopy 2021)	Europe (MAPS III 2025)
Differentiated intraepithelial carcinoma	-	-	-
No ulceration; diameter ≤ 2 cm	Standard indications	Absolute indications	Recommended for use
No ulceration, diameter > 2 cm	Provided that the criteria for curative resection are met	Absolute indications	Recommended for use
Accompanied by ulcer formation, diameter ≤ 3 cm	Provided that the criteria for curative resection are met	Absolute indications	Recommended for use
Associated with ulcer formation, diameter > 3 cm	Endoscopic submucosal dissection resection is not recommended	Relative indications	Not recommended
Undifferentiated intraepithelial carcinoma	-	-	-
No ulceration; diameter ≤ 2 cm	This should be chosen with due care following careful consideration	Absolute indications	This could be considered for implementation
Submucosal invasive carcinoma (SM1, depth of invasion ≤ 500 μm)	-	-	-
Differentiated, longest diameter ≤ 3 cm	Following pathological assessment, the patient is deemed eligible for curative resection	Relative indications	This could be considered for implementation