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(PATHWAY A: ENDOSCOPIC RESECTION, PATHWAY B: SURGERY, PATHWAY C: NON…
PATHWAY A: ENDOSCOPIC RESECTION
Indications:
Lesion ≤2 cm
Well/moderately differentiated
No LVI
Superficial invasion (sm <500 µm)
Techniques:
ESD (preferred)
EMR
Post-ER Pathology:
Favorable → Surveillance
Unfavorable → Surgery if medically fit
Surveillance Schedule:
EGD every 6 months (year 1)
EGD annually (years 2-5)
CT as clinically indicated
PATHWAY B: SURGERY
Indications:
≥T1b
Actively bleeding
Unfavorable histology
Patient preference
Procedures:
Distal gastrectomy
Subtotal gastrectomy
Total gastrectomy
Lymphadenectomy:
D1 or D2
Goal: ≥16 lymph nodes
Post-op: Observation (pTis/pT1a/pT1b N0)
PATHWAY C: NON-SURGICAL CANDIDATES
ER if technically feasible
Palliative management (GAST-9)