Clinical Eligibility & Pathology Criteria for Early GI Cancer ESD

1. Japanese Gastric Cancer Association (JGCA) Absolute & Expanded Indications

Shanghai Tongji Hospital adopts the international JGCA consensus guidelines for endoscopic curative resection:

• Differentiated Early Adenocarcinoma: Lesions of any diameter without ulceration (UL0) confined to the mucosa (M);
• Differentiated Lesions with Ulceration (UL1): Mucosal tumor size ≤ 30mm;
• Superficial Submucosal Invasion (SM1): Differentiated adenocarcinoma with histological depth < 500μm into the submucosa, size ≤ 30mm;
• Undifferentiated / Signet Ring Cell Carcinoma: Strictly non-ulcerated (UL0) and restricted to mucosa (M) with size ≤ 20mm.

2. Diagnostic Modalities for Depth Verification

Prior to scheduling ESD, patients undergo multi-modal diagnostic validation:

1. Endoscopic Ultrasound (EUS): 20MHz radial or miniature probe ultrasound to verify that the third hyperechoic layer (muscularis propria) remains intact;
2. Magnifying Endoscopy with Narrow-Band Imaging (ME-NBI): Fine evaluation of vascular (microvascular pattern, VP) and surface (microsurface pattern, MSP) demarcation lines;
3. Chest & Abdominal High-Resolution Thin-Slice CT: Exclude perigastric or mesenteric lymph node enlargement and visceral metastasis.

3. Checklist for International Case Review Submission

International patients seeking an ESD evaluation from Prof. Xu Shuchang should submit the following records:

• Original endoscopic examination images or HD video clips (.mp4 / .mov);
• Histopathology biopsy report detailing histological subtype and differentiation degree;
• Contrast-enhanced abdominal CT in DICOM format (via cloud download link);
• Current medical history (anticoagulant medication use, cardiovascular status).

Source: Department of Gastroenterology, Tongji Hospital Affiliated to Tongji University. Multidisciplinary review assesses clinical indications only and does not constitute a guaranteed visa issuance or surgery outcome. All medical fees are billed directly by Shanghai Tongji Hospital in accordance with statutory public hospital categories.

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