Endoscopic diagnosis and treatment of early gastric cardia neoplasms: Efficacy and management of non-curative resection

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 21, 2026; 32(43): 120660
Published online Nov 21, 2026. doi: 10.3748/wjg.120660

Table 1 Differences in clinical characteristics of cardiac mucosal lesions with different degrees of differentiation, n (%)/median (interquartile range)

Item	Low-grade intraepithelial neoplasia (n = 34)	High-grade intraepithelial neoplasia (n = 40)	Intramucosal carcinoma (n = 74)	Submucosal carcinoma (n = 15)	P value
Sex (%)					0.021
Male	24 (70.6)^a	37 (92.5)^a	66 (89.2)^a	11 (73.3)^a
Female	10 (29.4)^a	3 (7.5)^a	8 (10.8)^a	4 (26.7)^a
Age (years)	56.2 (44.3-68.1)^a	64.5 (55.8-73.2)^a	63.5 (55.3-71.7)^a	69.2 (59.4-79.0)^a	< 0.001
Age groups (years)					0.005
≤ 44	4 (11.8)^a	1 (2.5)^a	1 (1.4)^a	0^a
45-64	22 (64.7)^a	17 (42.5)^a	41 (55.4)^a	4 (26.7)^a
≥ 65	8 (23.5)^a	22 (55.0)^a	32 (43.2)^a	11 (73.3)^a
BMI (kg/m²)	25.4 (17.8-29.7)^a	23.0 (17.7-30.1)^a	23.1 (16.0-28.7)^a	23.8 (14.5-26.9)^a	0.010
BMI groups					0.049
< 18.5	2 (5.9)^a	2 (5.0)^a	5 (6.8)^a	1 (6.7)^a
18.5-23.9	9 (26.5)^a	23 (57.50)^a	40 (54.1)^a	7 (46.7)^a
24-27.9	17 (50.0)^a	11 (27.5)^a	27 (36.5)^a	7 (46.7)^a
> 28	6 (17.6)	4 (10.0)	2 (2.7)	0
Comorbidities (%)
Diabetes	0	7 (17.5)	7 (9.6)	1 (6.7)	0.056
Hypertension	9 (26.5)	12 (30.0)	18 (24.3)	4 (26.7)	0.934
Cardiovascular disease	3 (8.8)	7 (17.5)	12 (16.4)	2 (13.3)	0.712
Cirrhosis/hepatitis	0^a	0^a	8 (10.8)^a	0^a	0.026
Respiratory disease	1 (2.9)	3 (7.5)	3 (4.1)	1 (6.7)	0.650
Reflux esophagitis	4 (11.8)	6 (15.0)	8 (10.8)	2 (13.3)	0.884
Barrett’s esophagus	5 (14.7)^a	1 (2.5)^a	0^a	0^a	0.003
Atrophic gastritis	20 (58.8)^a	36 (90.0)^a	59 (79.7)^a	11 (73.3)^a	0.014
Helicobacter pylori infection (%)	5 (14.7)	7 (17.5)	10 (13.5)	1 (6.7)	0.830
Smoking history (%)	7 (20.6)	17 (42.5)	31 (41.9)	8 (53.3)	0.085
Alcohol history (%)	7 (20.6)	9 (22.5)	18 (24.3)	4 (26.7)	0.961
Family history (%)	5 (14.7)	1 (2.5)	6 (8.1)	1 (6.7)	0.269

^aP < 0.05.

BMI: Body mass index.

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Table 2 Differences in pathological characteristics of cardiac mucosal lesions, n (%)/median (interquartile range)

Item	Low-grade intraepithelial neoplasia (n = 34)	High-grade intraepithelial neoplasia (n = 40)	Intramucosal carcinoma (n = 74)	Submucosal carcinoma (n = 15)	P value
Lesion major diameter (cm)	2.5 (1.4-3.6)^a	2.9 (1.8-4.0)^a	3.2 (1.8-4.6)^a	3.0 (1.7-4.3)^a	0.021
Lesion location (%)					0.088
E/EG type	9 (26.5)	6 (15.0)	6 (8.1)	2 (13.3)
E = G type	16 (47.1)	20 (50.0)	31 (41.9)	9 (60.0)
GE/G type	9 (26.5)	14 (35.0)	37 (50.0)	4 (26.7)
Lesion depth (%)					< 0.001
M1, M2	34 (100.0)^a	34 (85.0)^a	37 (50.0)^a	0^a
M3	0^a	2 (5.0)^a	37 (50.0)^a	0^a
SM1	0^a	4 (10.0)^a	0^a	11 (73.3)^a
SM2	0^a	0	0	4 (26.7)^a
Pathological type (%)					< 0.001
Glandular epithelial	17 (50.0)^a	34 (85.0)^a	73 (98.6)^a	15 (100.0)^a
Squamous epithelial	12 (35.3)^a	6 (15.0)^a	1 (1.4)^a	0^a
Mixed glandular/squamous	5 (14.7)^a	0^a	0^a	0^a

^aP < 0.05.

E/EG type: Tumor center above the esophagogastric junction, predominantly on the esophageal side; E = G type: Tumor center precisely at the esophagogastric junction, involving both the esophagus and stomach; GE/G type: Tumor center below the esophagogastric junction, predominantly on the gastric side; M: Tumor is confined to the mucosa; SM1: Tumor invading the superficial submucosa (< 500 μm from the muscularis mucosae); SM2: Tumor invading the deep submucosa (≥ 500 μm).

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Table 3 Differences in white light endoscopy features, n (%)

Item	Low-grade intraepithelial neoplasia (n = 34)	High-grade intraepithelial neoplasia (n = 40)	Intramucosal carcinoma (n = 74)	Submucosal carcinoma (n = 15)	P value
Lesion location (%)					0.892
Greater curvature	5 (17.2)	3 (8.8)	12 (16.4)	1 (6.7)
Lesser curvature	10 (34.5)	9 (26.5)	19 (26.0)	4 (26.7)
Anterior wall	3 (10.3)	2 (5.9)	7 (9.6)	1 (6.7)
Posterior wall	11 (14.4)	20 (58.8)	35 (47.9)	9 (60.0)
Paris classification (%)					0.001
Elevated	13 (38.2)^a	3 (7.5)^a	7 (9.5)^a	1 (6.7)^a
Flat	20 (58.8)^a	28 (70.0)^a	56 (75.7)^a	9 (60.0)^a
Depressed	1 (2.9)^a	2 (5.0)^a	2 (2.7)^a	1 (6.7)^a
Mixed	0^a	7 (17.5)^a	9 (12.2)^a	4 (26.7)^a
Roughness (%)	18 (52.9)	23 (57.5)	49 (66.2)	10 (66.7)	0.536
Redness (%)	20 (58.8)	31 (77.5)	55 (74.3)	7 (46.7)	0.057
Whitening (%)	5 (14.7)	0	1 (1.4)	0	0.005
Ulceration or erosion (%)	6 (17.6)	7 (17.5)	15 (20.3)	4 (26.7)	0.876
White fur/coating (%)	4 (11.8)	4 (10.0)	16 (21.6)	4 (26.7)	0.248
Spontaneous bleeding (%)	0	2 (5.0)	4 (5.4)	0	0.573
Fold abnormality (%)	0	0	0	0
Poor peristalsis (%)	0	0	5 (6.8)	1 (6.7)	0.214

^aP < 0.05.

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Table 4 Magnifying endoscopy with narrow-band imaging features (squamous epithelium), n (%)

Item	Low-grade intraepithelial neoplasia (n = 6)	High-grade intraepithelial neoplasia (n = 5)	Intramucosal carcinoma (n = 1)	P value
Intrapapillary capillary loop types (%)				0.031
A	5 (83.3)^a	0^a	0^a
B1	1 (16.7)^a	4 (80.0)^a	1 (100.0)^a
B2	0^a	1 (20.0)^a	0^a
B3	0	0	0

^aP < 0.05.

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Table 5 Magnifying endoscopy with narrow-band imaging features (adenomatous epithelium), n (%)

Classification	Low-grade intraepithelial neoplasia (n = 17)	High-grade intraepithelial neoplasia (n = 28)	Intramucosal carcinoma (n = 53)	Submucosal carcinoma (n = 10)	P value
Irregular microvascular pattern	5 (29.4)^a	17 (60.7)^a	45 (84.9)^a	10 (100.0)^a	< 0.001
Irregular microsurface pattern	5 (29.4)^a	21 (75.0)^a	37 (69.8)^a	8 (80.0)^a	0.006
Demarcation line	7 (41.2)^a	22 (78.6)^a	47 (88.7)^a	10 (100.0)^a	< 0.001

^aP < 0.05.

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Table 6 Comparison of white light imaging biopsy and postoperative pathology for early gastric cardia cancer diagnosis

Preoperative biopsy diagnosis	Postoperative pathology		Total
Preoperative biopsy diagnosis	Positive (HGIN + carcinoma)	Negative (LGIN)	Total
Positive (HGIN + carcinoma)	73	10	83
Negative (LGIN)	25	11	36
Total	98	21	119

HGIN: High-grade intraepithelial neoplasia; LGIN: Low-grade intraepithelial neoplasia.

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Table 7 Comparison of Magnifying Endoscopy Simple Diagnostic Algorithm for Early Gastric Cancer and postoperative pathology for early gastric cardia cancer diagnosis

Magnifying Endoscopy Simple Diagnostic Algorithm for Early Gastric Cancer	Postoperative pathology		Total
	Positive	Negative	Total
Positive	76	4	80
Negative	13	15	28
Total	89	19	108

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Table 8 Comparison of endoscopic ultrasonography and pathological staging

Endoscopic ultrasonography invasion depth	Pathological invasion depth			n
Endoscopic ultrasonography invasion depth	M (pT1a)	SM1 (pT1b)	SM2 (pT1b)	n
uT1a	60	68	0	68
uT1b	21	27	2	27
Total	81	95	2	95

M: Tumor is confined to the mucosa; pT1a: Pathological stage T1a, tumor confined to the mucosa (M layer); pT1b: Pathological stage T1b, tumor invading the submucosa (SM layer), further divided into SM1 (invasion < 500 μm from the muscularis mucosae) and SM2 (invasion ≥ 500 μm from the muscularis mucosae); SM1: Tumor invading the superficial submucosa (< 500 μm from the muscularis mucosae); SM2: Tumor invading the deep submucosa (≥ 500 μm); uT1a: Endoscopic ultrasonography stage T1a, tumor confined to the mucosa; uT1b: Endoscopic ultrasonography stage T1b, tumor invading the submucosa.

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Table 9 Sensitivity analysis of endoscopic ultrasonography for invasion depth

Invasion depth	Sensitivity	Specificity	Accuracy	Positive predictive value	Negative predictive value
uT1a	74.1	42.9	69.5	88.2	22.2
uT1b	42.9	74.1	69.5	22.2	88.2

uT1a: Endoscopic ultrasonography stage T1a, tumor confined to the mucosa; uT1b: Endoscopic ultrasonography stage T1b, tumor invading the submucosa.

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Table 10 Differences in surgical efficacy and safety, n (%)

Item	Low-grade intraepithelial neoplasia (n = 34)	High-grade intraepithelial neoplasia (n = 40)	Intramucosal carcinoma (n = 74)	Submucosal carcinoma (n = 15)	P value
Absolute indication	32 (94.1)^a	34 (85.0)^a	65 (87.8)^a	0^a	< 0.001
En bloc resection	34 (100.0)	40 (100.0)	74 (100.0)	15 (100.0)
Complete resection	33 (97.1)^a	36 (90.0)^a	57 (77.0)^a	9 (60.0)^a	0.004
Curative resection	31 (91.2)^a	33 (82.5)^a	50 (67.6)^a	5 (33.3)^a	< 0.001
Complications	0	2 (5.0)	0	1 (6.7)	0.073
Intraoperative bleeding	0	0	0	0
Delayed bleeding	0	2 (5.0)	0	1 (6.7)	0.281
Perforation	0	0	0	0

^aP < 0.05.

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Table 11 Multivariate analysis of pathological underestimation

Related factors	Categories	P value	Odds ratio	95%CI
Sex	Male	0.017	1	1.271-32.139
Sex	Female	0.017	6.391	1.271-32.139
Differentiation degree	Low-grade intraepithelial neoplasia	0.045	0.086	0.008-0.952
Differentiation degree	Submucosal carcinoma	0.045	1	0.008-0.952

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Table 12 Multivariate analysis of factors related to incomplete resection

Related factors	Categories	P value	Odds ratio	95%CI
Lesion size	-	0.044	0.641	0.416-0.988
Mucosal redness	Yes	0.010	0.140	0.032-0.623
Mucosal redness	No	0.010	1	0.032-0.623

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Table 13 Comparison of causes for noncurative resection

Item	Low-grade intraepithelial neoplasia (n = 3)	High-grade intraepithelial neoplasia (n = 7)	Intramucosal carcinoma (n = 24)	Submucosal carcinoma (n = 10)	Total (n = 44)
Incomplete resection					25
Horizontal margin	1	3	13	4	21
Vertical margin	0	0	4	0	4
Complete resection with high-risk factors
Ulcer	2	2	6	3	13
SM2 invasion	0	1	1	3	5
Diameter > 3 cm	2	3	6	4	15
Lymphovascular invasion	0	0	1	1	2

A patient could have more than one cause for Noncurative resection. Therefore, the sum of subcategories may exceed the total number of patients in groups. SM2: Tumor invading the deep submucosa (≥ 500 μm).

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Table 14 Cross-study comparison of key indicators for noncurative resection patient management

Key indicators	Noncurative resection incidence (%)	Surgical group (%)	Positive postoperative pathology rate (%)
Our study	27.0	15.9	0
Cao et al[11]	19.5	43.0	7.0
Yoshinaga et al[8]	28.0	28.6	0
Jang et al[9]	34.0	30.0	-
Osumi et al[10]	18.4	62.5	0

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Citation: Zhu N, Chen MY, Li KQ, Li FL, Qin B, Jiang J, Wang SH, Wu J, Xi WT, Liu SY, Li YH, Zou BC. Endoscopic diagnosis and treatment of early gastric cardia neoplasms: Efficacy and management of non-curative resection. World J Gastroenterol 2026; 32(43): 120660
URL: https://www.wjgnet.com/1007-9327/full/v32/i43/120660.htm
DOI: https://dx.doi.org/10.3748/wjg.120660

Zhu N, Chen MY, Li KQ, Li FL, Qin B, Jiang J, Wang SH, Wu J, Xi WT, Liu SY, Li YH, Zou BC. Endoscopic diagnosis and treatment of early gastric cardia neoplasms: Efficacy and management of non-curative resection. World J Gastroenterol 2026; 32(43): 120660 [DOI: 10.3748/wjg.120660]

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