Who is a good candidate for ESD, and who is not?

Ideal candidates are patients with early gastric cancer (T1a) limited to the mucosa, typically ≤2 cm, without lymph node metastasis. Indications include differentiated-type adenocarcinoma and certain undifferentiated types meeting strict size criteria. Contraindications include suspicion of deep submucosal invasion (≥500 μm), lymph node or distant metastases, bleeding disorders, or inability to tolerate sedation. A thorough endoscopic ultrasound and CT staging are required to confirm eligibility.