Feasibility study of cap-assisted endoscopic mucosal resection for gastric adenocarcinoma of fundic gland type

BACKGROUND: Gastric adenocarcinoma of fundic gland type (GA-FG) is a rare subtype that typically arises in the upper stomach, making endoscopic submucosal dissection (ESD) technically challenging. Cap-assisted endoscopic mucosal resection (EMRC) is widely used for early gastric cancer due to its shorter procedure time and improved safety profile. We evaluated its efficacy and safety for GA-FG. METHODS: We retrospectively analyzed patients with GA-FG who underwent EMRC or ESD between April 2013 and September 2024. Outcomes included en bloc, complete, and curative resection rates; procedure time; and adverse events. Odds ratios (ORs) were estimated using logistic regression, and inverse probability of treatment weighting was applied for adjustment. RESULTS: We enrolled 70 patients with 77 lesions that were treated by EMRC (n = 57) or ESD (n = 20). En bloc resection was achieved in 100% of both groups. Complete resection rates were 96.5% for EMRC and 100% for ESD (P = 1.00). The EMRC group had significantly shorter median procedure time (6 vs. 46 min, P < 0.001) and fewer adverse events (OR 0.05, 95% CI 0.003-0.36; P = 0.002). No significant differences were found in curative resection (OR 3.47, 95% CI 0.86-14.08; P = 0.08) and intraoperative perforation (10% in the ESD group, 0% in the EMRC group; P = 0.06). CONCLUSIONS: Our findings suggest that EMRC is a safe and effective treatment for GA-FG, offering shorter procedure times and a lower risk of complications compared with ESD.