Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2024; 16(8): 439-444
Published online Aug 16, 2024. doi: 10.4253/wjge.v16.i8.439
Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer: The puzzle of eCura C1
Giulio Calabrese, Guido Manfredi, Marcello F Maida, Francesco V Mandarino, Endrit Shahini, Francesco Pugliese, Paolo Cecinato, Liboria Laterza, Emanuele Sinagra, Sandro Sferrazza
Giulio Calabrese, Sandro Sferrazza, Department of Gastroenterology and Endoscopy, ARNAS Civico–Di Cristina–Benfratelli, Palermo 90127, Sicilia, Italy
Guido Manfredi, Department of Gastroenterology and Digestive Endoscopy, Ospedale Maggiore, Crema 26013, Italy
Marcello F Maida, Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Sicilia, Italy
Francesco V Mandarino, Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan 20132, Lombardy, Italy
Endrit Shahini, Department of Gastroenterology, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
Francesco Pugliese, Department of Digestive and Interventional Endoscopy, Niguarda Hospital, ASST Niguarda, Milan 20162, Lombardy, Italy
Paolo Cecinato, Liboria Laterza, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant’Orsola, Bologna 40138, Emilia-Romagna, Italy
Emanuele Sinagra, Department of Gastroenterology and Endoscopy, Fondazione Instituto San Raffaele Giglio, Cefalù 90015, Palermo, Italy
Author contributions: Calabrese G, Sinagra E and Sferrazza S are the guarantors of the integrity of the entire study and contributed to the manuscript drafting and revision for important intellectual content; Manfredi G, Maida MF, Mandarino FV, Shahini E, Pugliese F, Cecinato P, and Laterza L wrote, reviewed and edited the manuscript. All authors contributed to manuscript editing and had full control over the preparation of the manuscript.
Conflict-of-interest statement: All authors have no proprietary, financial, professional, or other personal interest of any nature or kind in any product, service, and/or company that could be construed as influencing the position presented in, or the review of this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emanuele Sinagra, PhD, Doctor, Department of Gastroenterology and Endoscopy, Fondazione Instituto San Raffaele Giglio, Contrada Pietra Pollastra, Cefalù 90015, Palermo, Italy. emanuelesinagra83@googlemail.com
Received: May 12, 2024
Revised: June 19, 2024
Accepted: July 5, 2024
Published online: August 16, 2024
Processing time: 81 Days and 11.4 Hours
Abstract

In this editorial, we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection (ESD), starting from the consideration recently made by Zhu et al. Specifically, we evaluate the management of eCura C1 lesions, where decisions regarding further interventions are pivotal yet contentious. Collaboration among endoscopists, surgeons, and pathologists is underscored to refine risk assessment and personalize therapeutic management. Recent advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 lesions. Moreover, despite needing further clinical validation, molecular biomarkers have emerged as promising tools for enhancing prognostication. This manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options, ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; eCura; Non-curative resection; Multidisciplinary approach

Core Tip: This editorial details the management of early gastric cancer after endoscopic submucosal dissection (ESD), focusing on noncurative resections, especially eCura C1. Collaborative and personalized approaches are advisable in order to position patient treatment correctly. Recent advancements in ESD techniques offer promise for optimizing outcomes, but further validation is still needed. Future research to define effective treatment strategies and enhance patient prognostication through molecular biomarkers is expected to refine treatment protocols and advance strategies for managing eCura C1 lesions in ESD procedures.