This study aimed to characterize the dynamic changes in inflammation and T-lymphocyte subsets for early gastrointestinal cancer before and after endoscopic submucosal dissection (ESD) (pre-ESD; postoperative days 1, 7, and 30). A total of 189 patients with early gastrointestinal cancer who underwent ESD and achieved en bloc resection were enrolled, including 53 cases of early esophageal cancer, 55 cases of early gastric cancer, and 81 cases of early colorectal cancer. Patients were categorized into a non-R0 en bloc resection group (n=32), a non-curative R0 resection group (n=62), and a curative resection group (n=95). Clinical characteristics, T-lymphocyte subsets, inflammatory markers, and postoperative complications were analyzed. ESD significantly ameliorated T-lymphocyte subsets and inflammatory cytokines, with the most pronounced improvement observed in the curative resection group. Pre- and post-ESD levels of these markers were significantly correlated with lesion size, tumor morphology, and depth of invasion. The non-R0 en bloc resection group had a markedly higher complication rate than the other groups, whereas the curative resection group showed the lowest rate. Improvements in immune and inflammatory indices after ESD did not differ significantly among early cancers of different sites. The postoperative complication incidence was not associated with tumor sites. ESD markedly ameliorates the imbalance between T-lymphocyte subsets and inflammatory cytokine levels in early gastrointestinal cancer, with these indicators showing strong correlations with lesion size, tumor morphology, and depth of invasion. Curative resection demonstrates the greatest therapeutic benefit and the lowest postoperative complication rate.

BackgroundEndoscopic submucosal dissection (ESD) is established as a key minimally invasive, function-preserving technique for early-stage esophageal cancer, valued for its high rate of en bloc resection. This study aims to provide a comprehensive bibliometric and visual analysis of research on ESD in esophageal cancer from 2006 to 2025.Material/MethodsA systematic literature search was performed in the Web of Science Core Collection. Bibliometric analysis and visualization were conducted using VOSviewer, CiteSpace, and the R package “bibliometrix”.ResultsA total of 512 original research articles were included in the analysis. Japan and China collectively contributed over 82% of the total output, with Japanese institutions and authors dominating in productivity and citation impact. Keyword co-occurrence analysis identified 5 thematic clusters: (1) post-ESD complication management; (2) early diagnosis and risk lesion detection; (3) survival analysis and prognostic indicators; (4) adjunctive and supportive therapies; and (5) endoscopic technique and visualization. Recent keyword bursts since 2020 highlighted emerging priorities including “risk factors”, “early esophageal cancer”, and “prevention”.ConclusionsThis bibliometric analysis reveals a clear research trajectory in ESD for esophageal cancer, shifting from foundational technique refinement toward multimodal and personalized management strategies. These findings provide a structured reference for identifying research priorities, fostering international collaboration, and guiding future investigations in this field.

Endoscopic submucosal dissection (ESD) has become a first-line treatment for early esophageal cancer and precancerous lesions; however, non-curative resection (N-CR) occurs in a significant proportion of cases, necessitating additional surgical or chemoradiotherapy treatment. This study aimed to analyze the risk factors associated with N-CR following ESD and compare the efficacy of different secondary treatment strategies. We conducted a retrospective analysis of 306 patients who underwent ESD for early esophageal lesions at The Fourth Hospital of Hebei Medical University between January 2017 and December 2021. Patients were divided into curative resection (CR) and non-curative resection (N-CR) groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for N-CR. A predictive nomogram model was constructed using R software. For the 49 patients with N-CR, we compared recurrence rates at 3months, 1year, and 2years among three treatment strategies: no additional treatment (n = 22), surgical resection (n = 17), and chemoradiotherapy (n = 10). The overall N-CR rate was 16.0% (49/306). Multivariate analysis identified four independent risk factors for N-CR: gastroscopic pathology (OR = 0.186, 95% CI: 0.037-0.948, P = 0.043), depth of infiltration (OR = 0.012, 95% CI: 0.002-0.077, P < 0.001), lesion location (OR = 0.185, 95% CI: 0.038-0.890, P = 0.035), and gross morphological type (OR = 0.018, 95% CI: 0.002-0.209, P = 0.001). The nomogram demonstrated good predictive accuracy. The 2-year recurrence rates were 18.18% for the no-treatment group, 11.79% for the surgical group, and 10.00% for the chemoradiotherapy group. No significant differences in overall survival or disease-free survival were observed among the three groups (P > 0.05). ESD is a safe and effective treatment for early esophageal lesions. Gastroscopic pathology, depth of infiltration, lesion location, and gross type are independent predictors of N-CR. The predictive nomogram can assist clinical decision-making. Both surgical resection and chemoradiotherapy provide effective secondary treatment options for N-CR cases, with comparable oncological outcomes.

Endoscopic and surgical management of early esophageal cancer: Current evidence and evolving oncologic strategies

Esophageal cancer (EC) is frequently detected at an advanced stage because of the lack of effective noninvasive screening tools, leading to poor prognosis. This study aimed to identify serum transfer RNA-derived small RNA (tsRNA) biomarkers for early detection of EC. Candidate tsRNAs were screened using the tsRFun database, and a quantitative real-time PCR (qRT‒PCR) method for serum 5'tRF-Val was subsequently established and validated. A total of 289 participants were enrolled, including 124 EC patients (71 with early-stage, 53 with advanced-stage disease), 56 individuals with benign lesions, 77 healthy subjects, and 32 postoperative EC patients. Detection performance was evaluated by receiver operating characteristic (ROC) curve analysis, and correlations with clinicopathological parameters were examined. 5'tRF-Val levels were significantly higher in the serum of EC patients than in that of healthy subjects. Its expression correlated positively with aggressive pathological features, including advanced TNM stage and the presence of metastasis. Notably, 5'tRF-Val demonstrated high detection accuracy for early-stage EC, with an AUC of 0.857. Importantly, it effectively distinguished early EC lesions from benign lesions (AUC = 0.824). Furthermore, longitudinal analysis revealed a significant decrease in 5'tRF-Val levels following radical surgery, suggesting its potential for monitoring treatment response. Serum 5'tRF-Val was identified in this study as a novel and promising noninvasive biomarker for the early detection of EC. Owing to its high detection accuracy, association with disease progression, and postoperative dynamic changes, 5'tRF-Val may help to fill the current gap in noninvasive detection of early EC, but this needs to be further verified in multicentre studies.

Synchronous multiple lesions are not uncommon in patients with early esophageal cancer. Endoscopic submucosal dissection (ESD) provides an effective and safe treatment while preserving esophageal integrity. Single session ESD is generally performed for synchronous multiple early esophageal cancers, offering the advantage of reduced medical costs. However, when the lesions are adjacent, extensive mucosal defect after ESD increases the risk of refractory stricture. In this case, we described a strategy-staged ESD for the prevention of stricture following extensive resection of synchronous multiple early esophageal cancers.

Esophageal endoscopic submucosal dissection (E-ESD) is a key treatment modality for early-stage esophageal cancer. However, data on the E-ESD learning curve remains relatively scarce. This study explores E-ESD learning patterns of endoscopists with different experience to inform training. A 2014-2023 single-center retrospective study analyzed 300 E-ESDs (150 cases each performed by senior endoscopists [SE] and junior endoscopists [JE]), stratified into 3 phases (1-50, 51-100, 101-150 cases). CUSUM and moving averages assessed the learning curve, with key indicators including resection speed, en bloc/R0 rates, and perforation rate. As case numbers increased, both endoscopists' key indicators improved. SE had significantly higher median resection speed than JE in Phase 1 (5.59 vs. 3.87 cm2/h, P = 0.001) and 3 (10.14 vs. 7.21 cm2/h, P < 0.001). En bloc rates rose to 96% (SE) and 94% (JE); R0 rates to 96% (SE) and 94% (JE) (no intergroup differences, P > 0.05). The perforation rate decreased from 22 to 6% for SE and from 12 to 2% for JE. CUSUM showed proficiency at 59 (SE) and 61 (JE) cases. In our single-center study, a junior endoscopist reaches similar efficacy to a senior after about 60 cases for proficiency. Performance differs mainly in resection speed, indicating experience improves efficiency not core outcomes. These exploratory findings, derived from a limited sample of two operators, support E-ESD training but are not definitive benchmarks.

Chen et al published a study in the recent issue of World Journal of Gastrointestinal Surgery evaluated the high-performance fluorescent probe DAF-FM provides a significant advancement in early esophageal cancer detection. DAF-FM enables real-time monitoring of nitric oxide during esophagitis-to-cancer transformation, with concentration-dependent and time-dependent fluorescence, lysosomal targeting, and low cytotoxicity. In preclinical models, DAF-FM fluorescence strongly correlates with tumor volume (R ² = 0.87) and demonstrates superior sensitivity compared to endoscopic biopsy. These findings position DAF-FM as a rapid, non-invasive, and clinically relevant tool for early diagnosis and treatment monitoring in high-risk esophagitis patients.

Post-ESD esophageal stricture remains a major complication despite steroid prophylaxis. Temporary stent placement has been proposed as an adjunctive strategy in high-risk cases, yet its independent effect remains uncertain due to treatment selection bias. We aimed to evaluate the association between adjunctive stent placement and post-ESD stricture using multiple adjustment strategies, including inverse probability of treatment weighting (IPTW). In this retrospective cohort study of 89 patients receiving standardized steroid prophylaxis, 31 additionally underwent temporary fully covered self-expanding metal stent placement. Multivariable logistic regression, IPTW, and doubly robust models were applied to address baseline imbalances. Conventional multivariable adjustment did not demonstrate a statistically significant association between stent placement and stricture (aOR 2.07, 95% CI 0.68-6.31). However, after IPTW adjustment with adequate covariate balance (all standardized mean differences < 0.1), stent placement was associated with increased stricture risk (OR 2.39, 95% CI 1.21-4.73). This finding persisted in doubly robust analysis (OR 2.55, 95% CI 1.24-5.25). Increasing age was independently associated with stricture across models. Analytical approach substantially influenced effect estimates. While conventional regression did not detect a significant association, IPTW-based analyses suggested a potential increase in stricture risk with adjunctive stenting. These findings underscore the importance of addressing treatment selection bias and warrant prospective validation.

Digital TNA-CHA-TR-FRET platform for ultrasensitive miRNA detection in serum: A diagnostic tool for early esophageal cancer.

Esophageal whitish plaques are common findings in large-scale esophageal cancer screenings, requiring accurate preliminary differentiation to guide appropriate clinical management. This study presents a computer-aided diagnosis (CAD) system based on the pre-trained large-scale visual-language (VL) model BLIP for automated diagnosis and description of esophageal whitish plaques. A dataset of 13,922 endoscopic images was used for model training, and comparative experiments were conducted with multiple benchmark models, including Poolformer, Swin-Transformer, TransMSF, and ViT. The results demonstrate that our approach outperforms existing methods in terms of precision, recall, F1 score, and accuracy. Compared with LLaVA-Med, our model significantly improves keyword accuracy (K-ACC) in medical text descriptions. A human-machine competition further demonstrated that our model outperforms both senior and junior endoscopists, particularly excelling in the recall of early esophageal cancer cases. These findings suggest that integrating pre-trained VL models into CAD systems can enhance the accuracy and efficiency of esophageal whitish plaque diagnosis, reducing misdiagnoses and supporting clinical decision-making.

The outcomes of patients with upper gastrointestinal tract cancer are poor, and early detection is critical. This study investigated the impact of standardized endoscopic imaging on the early detection rate of upper gastrointestinal tract cancers. A quasi-experimental study was conducted between July 2022 and July 2023. Four tertiary hospitals were randomized to the control and standardized endoscopic groups. The physicians in the standardized endoscopic group underwent standardized endoscopy training and applied standardized endoscopic imaging procedures. The physicians in the control group applied routine endoscopic procedures. The numbers of early and advanced upper gastrointestinal tract cancers in both groups were determined and compared. In the control group, there were 1175 cases of upper gastrointestinal malignant tumors, including 39 cases of early esophageal cancer and 104 cases of early gastric cancer. The early endoscopic detection rate was 12.17% in the control group. In the standardized procedure group, there were 1184 cases of upper gastrointestinal malignant tumors, including 71 cases of early esophageal cancer and 182 cases of early gastric cancer, with an early detection rate of 21.36%. The detection rates with the standardized procedure were also higher for early-stage esophageal (14.86% vs 7.93%, P = .019) and gastric (25.78% vs 15.23%, P = .032) cancers. Using standardized endoscopic procedures may improve the early detection rate of esophageal and gastric cancers.

Early esophageal cancer is prone to lymphovascular invasion (LVI) and ductal involvement (DI), which seriously affects the prognosis of patients. Therefore, identifying the potential risk factors for LVI/DI is crucial. This study aims to clarify endoscopic appearances which are predictive for LVI/DI in patients with node-negative superficial esophageal squamous cell carcinoma (SESCC). A total of 401 lesions were included for model development. Endoscopic image features were selected through multivariate logistic regression and LASSO (least absolute shrinkage and selection operator) regression analysis, and the optimal model was determined by calculating cNRI (continuous net reclassification improvement) and IDI (integrated discrimination improvement). Additionally, internal and external validation were performed using data from 173 and 133 lesions, respectively. Five endoscopic image features, including lesion length, macroscopic type, surface granularity, surface nodularity, and surface erosion, were identified as predictive factors and were incorporated into the nomogram. The nomogram demonstrated substantial predictive efficacy, as evidenced by the AUC (area under curve) values of 0.854 (95% CI: 0.809-0.899) for the training set, 0.821 (95% CI: 0.749-0.894) for the internal validation set, and 0.860 (95% CI: 0.765-0.955) for the external validation set. Calibration curves showed good agreement between the nomogram predictions and actual observations. DCA (decision curve analysis) and CICs (clinical impact curves) confirmed the nomogram's clinical applicability. We constructed a nomogram based on preoperative endoscopic image features for predicting the risks of LVI/DI in patients with node-negative SESCC, which may aid in clinical decision-making.

ABSTRACTCongenital esophageal muscularis propria defects are extremely rare, often complicating endoscopic submucosal dissection (ESD) for esophageal neoplasms. We report a 60‐year‐old man with early esophageal squamous cell carcinoma who underwent ESD. Intraoperatively, a congenital muscularis propria defect was incidentally identified as a translucent, respiration‐synchronized submucosal membrane, which exposed mediastinal structures after perforation. The defect was successfully managed via endoscopic endoclip‐nylon loop purse‐string closure. The patient recovered uneventfully, with pathologically confirmed negative margins and no diverticulum or stenosis at 3‐month follow‐up endoscopy. This case highlights that timely endoscopic recognition and management of such defects during ESD can avoid surgical intervention and ensure favorable outcomes, providing practical insights for endoscopists.

Endoscopic submucosal dissection (ESD) is the preferred treatment for early esophageal cancer. However, extensive mucosal dissection frequently results in esophageal stricture. This study aimed to evaluate the efficacy of Three-dimensional (3D)-printed silk fibroin scaffolds (SFS) loaded with adipose-derived stem cells (ADSCs) in preventing post-ESD esophageal stricture, and to explore the underlying mechanisms. A near-circumferential ESD model was established in pigs, three groups were set: Control, SFS and ADSCs-SFS. The dynamic change of postoperative esophageal healing and stricture formation were monitored endoscopically. On postoperative Day 28, esophageal specimens were collected to measure mucosal contraction rate, followed by histological evaluation of inflammation and fibrosis, as well as mRNA transcriptome sequencing to analyze gene expression and the change of the enriched signaling pathways. On Day 28, the ADSCs-SFS group showed significantly less weight loss and a markedly reduced mucosal contraction rate. Histological examination revealed more complete mucosal regeneration and significantly reduced collagen deposition in the ADSCs-SFS group. Molecular analyses indicated significant downregulation of inflammatory and fibrotic markers in the ADSCs-SFS group. Transcriptome analysis suggested that ADSCs-loaded SFS effectively alleviates esophageal stricture following ESD in pigs, likely through suppression of the PI3K/AKT signaling pathway and reduction of inflammation and fibrosis.

Abstract Aim Endoscopic mucosal resection (EMR) is a key technique in the staging and endoscopic management of early oesophageal adenocarcinoma. We report our tertiary resection centre’s experience over a 7-year period. Method All oesophageal adenocarcinoma EMR specimens, received by pathology from a single centre, between 01/2015 and 12/2022 were included. Outcome measures include nodule size; number of mucosecotmies per nodule; Presence of Negative Prognostic Indicators (NPIs): 1) submucosal involvement (T1b) 2) involved deep margin (R1) 3) lymphovascular invasion (LVI); Subsequent Oesophagectomy and resection T/N-stage; overall/disease related mortality; outcomes by NPI; and EMR complications. Results 87 patients underwent 181 mucosectomies: mean 2.1 per nodule (1-6); pT1b &amp;gt; pT1a (2.6 vs 1.8). Examining NPIs, 37 patients (42.5%) were pT1b; 21 (24.3%) had LVI; 21 (24.7%) were R1 at the deep margin. Oesophagectomy was performed in 16 patients, with 5 oesophagectomy patients (31.3%) found to have positive nodes. NPIs were positive predictors for surgery (HR 6.2) and disease related mortality (HR 2.7). Submucosal involvement was the highest individual predictor for surgery (HR 4.41), disease related mortality (HR 4.05), and node positivity at resection (HR 1.5). In patients with no NPIs, 39 (95.1%) were successfully managed with endoscopy only, and disease related mortality was reduced in this group (HR 0.38). EMR complication rate was 4.5%: 0 perforations, 1 haemorrhage, 3 strictures, and no deaths. Conclusions EMR safely stages early oesophageal adenocarcinoma and, if no NPIs, avoids the need for oesophagectomy in most patients. With NPI - and submucosal invasion in particular - proceeding to oesophagectomy should be carefully considered.

BACKGROUNDEndoscopic submucosal dissection (ESD) is a minimally invasive, safe, and efficient treatment technique for patients diagnosed with early esophageal cancer. However, postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life. As such, identification of relevant risk factors for recurrence can help optimize postoperative management strategies.AIMTo assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.METHODSClinical data from 210 patients diagnosed with early stage esophageal cancer, who underwent ESD at the authors’ center between March 2012 and March 2025, were retrospectively collected and analyzed. Patients were categorized into 2 groups according to postoperative disease recurrence: Recurrence (n = 30), and without recurrence (n = 180). Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period. Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.RESULTSDuring the follow-up period, 30 patients experienced tumor recurrence, corresponding to a recurrence rate of 14.19%. Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence [odds ratio (OR) = 1.782, 95% confidence interval (CI): 1.154-2.196; P < 0.001]. Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa (OR = 1.573, 95%CI: 1.073-2.481; P < 0.001). Furthermore, inability to completely resect the tumor greatly increased the likelihood of recurrence (OR = 2.189, 95%CI: 1.193-3.125; P = 0.001). Tumor diameter ≥ 2 cm was an independent risk factor for postoperative recurrence (OR = 1.981, 95%CI: 1.482-2.862; P = 0.005).CONCLUSIONRecurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation, depth of lesion invasion, complete resection status of the tumor, and tumor diameter.

Esophageal stricture following endoscopic submucosal dissection (ESD) for early esophageal cancer significantly impairs quality of life; this study aimed to develop a stricture prediction model and validate prophylactic efficacy of functional exercise combined with glucocorticoids for lesions involving ≥ 3/4 esophageal circumference. This retrospective study analyzed 1043 patients who underwent ESD between September 2015 and December 2024. Risk factors were identified using univariate and multivariate logistic regression. A nomogram and risk stratification system were developed. Separately, 70 patients with ≥ 3/4 circumferential involvement were compared. To mitigate selection bias, a propensity score-matched (PSM) cohort was generated by matching patients based on key baseline characteristics (including gender, age, smoking/drinking history, longitudinal length, postoperative pathological type, infiltration depth, and lesion location) using a 1:1 nearest neighbor method. This process yielded 44 matched patients (22 per group: GC + Exercise vs. GC), in whom the stricture rates, refractory stricture rates, time to stricture onset (days), and number of EBD sessions were compared. Esophageal stricture occurred in 49 patients. Independent risk factors included circumferential range, longitudinal length, infiltration depth, and lesion location. According to the risk of postoperative esophageal stenosis, a nomogram and risk stratification system were developed. Based on the predicted probability of esophageal stricture, patients are classified into low-risk (2.3%), intermediate-risk (48.8%), and high-risk categories (75%). Separately, in the PSM cohort, the GC + Exercise group (n = 22) showed significantly lower stricture rate (31.8% vs 63.6%, P = 0.035), refractory stricture rate (4.5% vs 31.8%, P = 0.046), delayed stricture onset (median 68.0 vs 33.0days, P = 0.009), and decreased EBD sessions (median 2.0 vs 4.5, P = 0.018). No adverse events were observed. Our nomogram accurately stratifies post-ESD stricture risk; for the primary risk factor (≥ 3/4 circumference), GC + Exercise demonstrated favorable prophylactic efficacy, representing an effective prevention strategy for extensive strictures.

Endoscopists performing upper gastrointestinal (UGI) endoscopy should train to recognize the appearance of early esophageal cancer and its precursor lesions, for Barrett neoplasia and for squamous neoplasia, to improve detection rates.Every endoscopist should have achieved competency in UGI endoscopy before commencing training in optical diagnosis in the UGI tract, and this requires personal experience of 300 UGI endoscopies and meeting the ESGE quality measures for UGI endoscopy. Endoscopists should undertake interactive training courses to improve diagnostic accuracy for esophageal preneoplastic and neoplastic lesions.Endoscopists should train with the Barrett's Oesophagus-Related Neoplasia (BORN) module to improve detection and delineation for early Barrett's esophagus-related neoplasia.Endoscopists should train in using the Prague classification to describe the circumferential and maximal extent of Barrett epithelium above the gastroesophageal junction.Endoscopists should train in using the Paris classification to describe suspected neoplastic lesions within both Barrett and squamous epithelium.Endoscopists should train in using virtual chromoendoscopy to assess both mucosal and vascular patterns in potentially neoplastic lesions in Barrett epithelium as being regular or irregular.When using acetic acid chromoendoscopy for Barrett's esophagus inspection, endoscopists should be familiar with the appearance of neoplastic lesions by assessing loss of aceto-whitening and mucosal surface patterns.Endoscopists should train in using the Japanese Esophageal Society (JES) classification to describe esophageal squamous cell lesions, to estimate the likelihood of and degree of dysplasia, and in the case of squamous cell cancer, the invasion depth.

BACKGROUNDThe incidence of esophageal cancer is high, and its prognosis is poor. Endoscopic submucosal dissection (ESD) is an important, minimally invasive treatment for early esophageal cancer, but the risk of postoperative bleeding affects its efficacy.AIMTo explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine (GBM) model for postoperative bleeding.METHODSThe clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively. Patients were divided into two groups (bleeding and non-bleeding). Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding, leading to the construction of the GBM prediction model. The receiver operating characteristic (ROC) curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan (BEST-J) score.RESULTSAmong 178 patients who received ESD treatment, 29 cases (16.29%) had bleeding, and 149 cases (83.71%) had no bleeding. The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group (P < 0.05). Multivariate logistic regression analysis showed that tumor size ≥ 3 cm, surgical bleeding, and C-reactive protein (CRP) were independent risk factors for bleeding after ESD in patients with early esophageal cancer (P < 0.05). The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score (0.818 vs 0.653, P < 0.05).CONCLUSIONThe GBM prediction model based on tumor size ≥ 3 cm, surgical bleeding, and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.