Zhou SQ, Ke QH. Endoscopic submucosal dissection in early esophageal neoplasia: Celebrating efficacy, confronting heterogeneity, and refining surveillance for high-risk patients. World J Clin Oncol 2026; 17(1): 113857 [PMID: 41608333 DOI: 10.5306/wjco.v17.i1.113857]
Corresponding Author of This Article
Qing-Hua Ke, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
Research Domain of This Article
Oncology
Article-Type of This Article
Letter to the Editor
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World J Clin Oncol. Jan 24, 2026; 17(1): 113857 Published online Jan 24, 2026. doi: 10.5306/wjco.v17.i1.113857
Endoscopic submucosal dissection in early esophageal neoplasia: Celebrating efficacy, confronting heterogeneity, and refining surveillance for high-risk patients
Shi-Qiong Zhou, Qing-Hua Ke
Shi-Qiong Zhou, Qing-Hua Ke, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
Author contributions: Ke QH wrote the first draft, developed the main ideas, and led revisions; Zhou SQ provided critical feedback, improved the structure, and added key examples; and all authors approved the manuscript and its submission to the journal.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Qing-Hua Ke, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
Received: September 5, 2025 Revised: September 27, 2025 Accepted: December 15, 2025 Published online: January 24, 2026 Processing time: 137 Days and 19.6 Hours
Abstract
Esophageal cancer poses a severe global healthcare burden, with a dismal prognosis primarily due to late-stage diagnosis - only 10%-30% of patients survive 5 years when symptoms trigger medical attention. Endoscopic submucosal dissection (ESD) has emerged as a transformative minimally invasive therapy for early esophageal neoplastic lesions, offering curative potential while preserving organ function. However, the clinical landscape of early esophageal neoplasia is highly heterogeneous, with low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, early-stage carcinoma, and superficial carcinoma differing significantly in biological behavior, endoscopic features, and treatment response. This article examines the recent retrospective study published by Zhang et al, which analyzed 245 patients with 264 lesions treated with ESD between 2014 and 2022. The study fills a critical gap in understanding this heterogeneity by systematically linking lesion stage to clinicopathological characteristics, ESD efficacy, and long-term prognosis. It not only validates ESD’s role in early disease but also raises urgent questions about refining stratified management and addressing unmet needs in high-risk populations. This article discusses the implications of the study’s findings, contextualizes them within current clinical practice, and outlines directions for future research to advance care for patients with early esophageal neoplasia.
Core Tip: This article explores early esophageal neoplastic lesions (low/high-grade intraepithelial neoplasia, early/superficial carcinoma) treated with endoscopic submucosal dissection, revealing heterogeneity in endoscopic/pathological features, curative resection rate, and prognosis. Key factors include non-curative resection, esophageal stricture, age, and prior cancer history. Biomarkers (Ki-67, p53) differ by lesion grade, correlating with invasion and treatment response, informing stratified management, adjuvant therapy, and personalized surveillance.
