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Vol.17 No.1
January, 2023
Frequency : Bimonthly
pISSN 1976-2283
eISSN 2005-1212 
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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Chiara Pierantoni 
, Andrea Lisotti , Pietro Fusaroli
Correspondence to: Chiara Pierantoni
ORCID https://orcid.org/0000-0003-2160-5685
E-mail chiarapierantoni@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2021;15(6):940-941. https://doi.org/10.5009/gnl210122
Published online June 22, 2021, Published date November 15, 2021
Copyright © Gut and Liver.
We have read with interest the article by Shin
The authors found that the LNM rate tended to be higher in papillary early gastric cancer (P-EGC) than in other differentiated types of EGC and that the rate increased to 25.6% when there was invasion of the submucosal layer.
Lymphovascular invasion was the only factor significantly associated with LNM in submucosal P-EGC. Moreover, location in the lower third of the stomach and elevated gross appearance were independent factors associated with lymphovascular invasion in submucosal P-EGC. Conversely, the depth of submucosal invasion, which is a known predictive factor against LNM in classic EGC, was not significantly associated with LNM.
These findings raise concern about the appropriateness of the current European guidelines that recommend the use of the same criteria for endoscopic submucosal dissection (ESD) as a treatment or both P-EGC and other differentiated EGCs.2 The feasibility of ESD for P-EGC is still debatable, in particular when it meets the expanded criteria.
Accurate assessment of the depth of invasion of EGC is critical for selecting the appropriate treatment option. Although endoscopic ultrasonography (EUS) has become the preferred tool for the locoregional staging of gastric cancer,3 there is no consensus on the accuracy of EUS for the evaluation of the invasion depth of EGC.4-6
However, several studies have shown the optimal accuracy of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of benign and malignant lesions.7-10 In particular, the diagnostic accuracy of CH-EUS in the differential diagnosis of lymph nodes was comparable to those of EUS elastography and EUS-guided fine needle aspiration.11 Therefore, the characterization of lymph nodes could represent the main target of EUS during EGC staging rather than the T parameter, especially for P-EGC.
Several studies performed on surgical specimens reported a worse prognosis associated with P-EGC than with other differentiated types.2,12 However, the treatment outcomes of ESD for P-EGC have not been precisely documented.12
A recent Korean study13 evaluated the short- and long-term outcomes after ESD in P-EGC; the curative resection rate of P-ECG was significantly lower than those of well differentiated and moderately differentiated EGC (49.4% vs 72.5% and 93.7%, respectively), although it increased to 72.5% for mucosal (T1a) cancer. Despite the poor short-term outcomes, the long-term outcomes of ESD for P-EGC were favorable once curative resection was achieved (no LNM, no extragastric recurrences and a low metachronous recurrence).
As discussed by the authors, qualitative endoscopic criteria evaluation and accurate staging should be adopted for the assessment of submucosal invasive P-EGC, although lymphovascular invasion is difficult to predict. Indeed, accurate staging, together with a radical endoscopic or surgical resection of gastric neoplasia can significantly improve patients’ clinical outcomes.14
In P-EGC accurate N staging is crucial due to the high rate of LNM even in the early stages. We think that EUS evaluation, together with CH-EUS, should therefore be included in the staging process for P-EGC. Further large-scale studies are needed to demonstrate whether the correct staging yield and prediction of lymphovascular invasion could be further improved.
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2021; 15(6): 940-941
Published online November 15, 2021 https://doi.org/10.5009/gnl210122
Copyright © Gut and Liver.
Chiara Pierantoni , Andrea Lisotti , Pietro Fusaroli
Gastroenterology Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, Imola, Italy
Correspondence to:Chiara Pierantoni
ORCID https://orcid.org/0000-0003-2160-5685
E-mail chiarapierantoni@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We have read with interest the article by Shin
The authors found that the LNM rate tended to be higher in papillary early gastric cancer (P-EGC) than in other differentiated types of EGC and that the rate increased to 25.6% when there was invasion of the submucosal layer.
Lymphovascular invasion was the only factor significantly associated with LNM in submucosal P-EGC. Moreover, location in the lower third of the stomach and elevated gross appearance were independent factors associated with lymphovascular invasion in submucosal P-EGC. Conversely, the depth of submucosal invasion, which is a known predictive factor against LNM in classic EGC, was not significantly associated with LNM.
These findings raise concern about the appropriateness of the current European guidelines that recommend the use of the same criteria for endoscopic submucosal dissection (ESD) as a treatment or both P-EGC and other differentiated EGCs.2 The feasibility of ESD for P-EGC is still debatable, in particular when it meets the expanded criteria.
Accurate assessment of the depth of invasion of EGC is critical for selecting the appropriate treatment option. Although endoscopic ultrasonography (EUS) has become the preferred tool for the locoregional staging of gastric cancer,3 there is no consensus on the accuracy of EUS for the evaluation of the invasion depth of EGC.4-6
However, several studies have shown the optimal accuracy of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of benign and malignant lesions.7-10 In particular, the diagnostic accuracy of CH-EUS in the differential diagnosis of lymph nodes was comparable to those of EUS elastography and EUS-guided fine needle aspiration.11 Therefore, the characterization of lymph nodes could represent the main target of EUS during EGC staging rather than the T parameter, especially for P-EGC.
Several studies performed on surgical specimens reported a worse prognosis associated with P-EGC than with other differentiated types.2,12 However, the treatment outcomes of ESD for P-EGC have not been precisely documented.12
A recent Korean study13 evaluated the short- and long-term outcomes after ESD in P-EGC; the curative resection rate of P-ECG was significantly lower than those of well differentiated and moderately differentiated EGC (49.4% vs 72.5% and 93.7%, respectively), although it increased to 72.5% for mucosal (T1a) cancer. Despite the poor short-term outcomes, the long-term outcomes of ESD for P-EGC were favorable once curative resection was achieved (no LNM, no extragastric recurrences and a low metachronous recurrence).
As discussed by the authors, qualitative endoscopic criteria evaluation and accurate staging should be adopted for the assessment of submucosal invasive P-EGC, although lymphovascular invasion is difficult to predict. Indeed, accurate staging, together with a radical endoscopic or surgical resection of gastric neoplasia can significantly improve patients’ clinical outcomes.14
In P-EGC accurate N staging is crucial due to the high rate of LNM even in the early stages. We think that EUS evaluation, together with CH-EUS, should therefore be included in the staging process for P-EGC. Further large-scale studies are needed to demonstrate whether the correct staging yield and prediction of lymphovascular invasion could be further improved.
No potential conflict of interest relevant to this article was reported.
pISSN 1976-2283
eISSN 2005-1212
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
