Indications - all of the following:
(1) one of the following histologic types:
(1a) well-differentiated adenocarcinoma OR
(1b) moderately differentiated adenocarcinoma OR
(1c) papillary adenocarcinoma
(2) confined to the mucosa
(3) one of the following dimensions
(3a) < 2.0 cm in maximum diameter AND Type IIA (superficially elevated) lesion, OR
(3b) < 1.0 cm in maximum diameter AND Type IIb (flat) lesion OR
(3c) < 1.0 cm in maximum diameter AND Type IIc (depressed) lesion
Contraindications - any of the following:
(1) ulceration OR ulcer scar
(2) invasion of lymphatics or venous channels
(3) poorly differentiated or signet ring cell adenocarcinomas
According to Gotoda et al, adenocarcinomas meeting the above criteria have a < 3% chance of lymph node metastases. The risk is almost 19% if there is invasion into the submucosa.
