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In the late 1990s the development of endoscopic submucosal dissection (ESD) using different knives revolutionized the spectrum of endoscopic resection techniques allowing en bloc resections regardless of the lesion’s size [5] . In combination with new data on the risk of lymph node metastases in early gastric cancer resection, criteria could be extended [6, 7] . The so-called expanded criteria include mucosal cancers without ulceration regardless of the lesion’s size, ulcerated mucosal cancers with a size restriction of 30 mm, and cancers with minute submucosal invasion of ! 500 m (also with a size restriction of 30 mm). Lesions with undifferentiated histology and lymphatic or vascular invasion are still excluded [7, 8] . In 2006 Oka et al. [9] confirmed the presumed advantages of the ESD method in comparison to EMR. ESD showed a significant improvement in en bloc resections and complete resections. For lesions without ulceration, the superiority of ESD was significant even for small lesions of

Endoscopic Therapy for Early Gastric Cancers – from EMR to ESD, from Guideline Criteria to Expanded Criteria