Faut-il faire une écho-endoscopie dans le cancer de l’estomac ?
Should an endosonography be performed in gastric carcinoma?
Gastric cancer is defined as a tumor the center of which is located at more than two cm below the cardia.
The “group of teachers in hepatogastroenterology” wrote in 1999  on the internet site of the SNFGE  that the treatment of gastric carcinoma is surgical and that “it is not necessary to make other explorations than endoscopy for gastric staging of gastric cancer”. This was generally accepted all over the world .
But since a couple of years, some new therapeutic options arose. Their place must be discussed according to the disease stage.
That is what is proposed in the “Japanese Gastric Cancer Association” guidelines . Similarly, the FFCD guidelines  express a difference of meaning with the “groupe des enseignants en hépato-gastro-entérologie”.
The Japanese Gastric Cancer Association  suggests to adapt modified gastrectomy techniques (MG A and MG B) and mucosectomy for superficial cancers responding to strict criteria. The choice of gastrectomy can also be modified according to the extension of advanced cancer. Inclusion of advanced gastric cancer in neoadjuvant treatment protocols is recommended.
The FFCD also recommends mucosectomy in superficial gastric cancer and inclusion of patients in neoadjuvant treatment protocols in advanced cancer. They focus on the usefulness of EUS in case of linitis suspicion.
Recent literature proposes alternative treatments as extended mucosal resection, tumor destruction by argon beam , different neoadjuvant protocols or non-curative treatments for specific situations of non-curable cancer [6–9].
Randomized prospective multicentric protocols of neoadjuvant treatments are organized by the American, Japanese, and European societies. We are expecting their results soon.
An editorial published in September 2003  says that a neoadjuvant chemotherapy treatment followed by surgery will soon be the new standard. This is already the case in some centers in Great Britain .
However, therapeutic choice depends of morphological and histological type, and even more of the disease staging. It is essentially to assess the transmural extension, the presence of neoplastic nodes, adjacent organs infiltration, and metastasis which could modify initial therapeutic choice.
The question is : should EUS play a role in pre-surgery staging? Therefore, we must know what is the accuracy of EUS and of mini-probes in the T and N staging of gastric cancer.
Then we will have to take another look at the alternative techniques and at their value.
cancer, endoscopic ultasonography, stomach