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 Gastrointest Oncol. Nov 15, 2026; 18(11): 121634
Published online Nov 15, 2026. doi: 10.4251/wjgo.121634
Published online Nov 15, 2026. doi: 10.4251/wjgo.121634
Proportion of esophageal keratinized area ≥ 30% reduces accuracy of preoperative endoscopic evaluation in early esophageal squamous cell carcinoma
Ying-Jie Zhang, Digestive Diseases, West China School of Medicine, Sichuan University, Sichuan University Affiliated Chengdu People's Hospital, Chengdu Second People's Hospital, No. 10 Qingyun South Street, Chengdu 610000, Sichuan Province, China
Wu Wen, Jing Yuan, De-Hong Zou, Department of Digestive Diseases, Chengdu Second People’s Hospital affiliated to West China School of Medicine, Sichuan University, Chengdu 610000, Sichuan Province, China
Fan Li, Hai-Peng Shi, Department of Pathology, Chengdu Second People’s Hospital affiliated to West China School of Medicine, Sichuan University, Chengdu 610000, Sichuan Province, China
Chuan Liang, Ye Yang, Department of Digestive Diseases, Chengdu Qingbaijiang District People's Hospital, Chengdu 610300, Sichuan Province, China
Author contributions: Zhang YJ and Wen W designed and conducted the study and wrote the paper; Yuan J contributed to the analysis; Li F, Zou DH, and Liang C provided clinical advice; Yang Y and Shi HP supervised the study. All authors commented on subsequent versions of the manuscript and have read and approved the final manuscript. All authors contributed to the study conceptualization and methodology.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Institutional review board statement: This study was approved by the Ethics Committee of Sichuan University Affiliated Chengdu Second People's Hospital prior to data collection, No. [KY]PJ2026049.
Informed consent statement: The requirement for an informed consent form was waived owing to the retrospective nature of the study, and it has little risk to patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Based on privacy reasons, data will be made available on request.
Corresponding author: Ying-Jie Zhang, Digestive Diseases, West China School of Medicine, Sichuan University, Sichuan University Affiliated Chengdu People's Hospital, Chengdu Second People's Hospital, No. 10 Qingyun South Street, Chengdu 610000, Sichuan Province, China.
Received: April 2, 2026
Revised: June 25, 2026
Accepted: October 9, 2026
Published online: November 15, 2026
Processing time: 207 Days and 6.1 Hours
Revised: June 25, 2026
Accepted: October 9, 2026
Published online: November 15, 2026
Processing time: 207 Days and 6.1 Hours
Core Tip
Core Tip: Esophageal keratosis in early esophageal squamous cell carcinoma (ESCC) is associated with tumor infiltration and may reflect invasion depth. Preoperative endoscopic assessment based on intraluminal papillary capillary loop morphology in nonkeratinized areas is reliable for most early ESCCs; however, its accuracy may decrease when the keratinized area accounts for ≥ 30% of the lesion. The extent of keratinization may also be related to lesion size, although further studies are needed to confirm these associations.