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Accurate endoscopic determination of invasion depth for gastric cancer is essential in making the proper decisions for planning treatment strategy. The use of endoscopic resection such as endoscopic submucosal dissection has become more widespread in treating early gastric cancer, particularly in Asia. As a result, differential endoscopic diagnosis between mucosal and submucosal depth of invasion has become increasingly important in determining the indications for endoscopic resection. Endoscopy is the primary modality for diagnosing gastric cancer. Correlations between macroscopic type and invasion depth for early gastric cancer have been reported in the Paris endoscopic classification of superficial neoplastic lesions; thus, the proper use of macroscopic classification is helpful in determining invasion depth. [ABSTRACT FROM AUTHOR]

We summarize the current status of endoscopic ultrasound (EUS) for the upper gastrointestinal (GI) tract solely in Asia, focusing on the staging of superficial cancers and the diagnosis of submucosal tumors (SMT), by analysis of questionnaire responses and a literature review. EUS for assessing the depth of superficial cancers of the upper GI tract is useful; however, evidence is lacking to support that EUS is superior to other modalities. The current status of EUS varies across different Asian countries, and standardization of the methods used both during the procedure and for depth subclassification is necessary to evaluate the diagnostic accuracy. Although EUS alone is limited in the diagnosis of SMT, EUS-guided fine-needle aspiration is an effective and safe diagnostic tool. Although there is a role for EUS, there are still many limitations both technically and in terms of accessibility., (© 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.)