Endoscopic Techniques for Early Esophageal Cancer

Early oesophageal cancer, defined as lesions confined to the mucosa or superficial submucosa, has seen a paradigm shift from radical surgery to organ-preserving endoscopic therapies. Key modalities include endoscopic mucosal resection, suited to small, well-demarcated lesions, and endoscopic submucosal dissection, which allows en bloc excision of larger or fibrotic tumours. High-definition imaging, chromoendoscopy and narrow-band imaging enhance detection of dysplasia and early carcinoma, while endoscopic ultrasound refines staging by assessing invasion depth and regional lymph nodes. Histopathological analysis of resection specimens—evaluating margin status, depth of submucosal invasion and lymphovascular involvement—guides decisions on additional treatment or surveillance. Collectively, these techniques deliver cure rates comparable to surgery, reduce procedural morbidity, preserve oesophageal function and support tailored follow-up protocols in a multidisciplinary setting.

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Endoscopic Techniques for Early Esophageal Cancer publication trend

The graph below shows the total number of articles in endoscopic techniques for early esophageal cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Endoscopic mucosal resection (EMR): Removal of superficial oesophageal lesions by excising the mucosal layer, either piecemeal or en bloc.

Endoscopic submucosal dissection (ESD): Precise en bloc removal of larger or fibrotic lesions via submucosal layer dissection under direct vision.

R0 resection: Complete excision of a lesion with histologically clear lateral and deep margins.

Lymphovascular invasion: Presence of cancer cells within lymphatic or vascular channels, indicating elevated metastatic risk.

Barrett’s oesophagus: Premalignant replacement of native squamous epithelium by specialised columnar mucosa, predisposed to adenocarcinoma.

Endoscopic ultrasound (EUS): Combined endoscopic and ultrasonographic imaging to stage tumour depth and detect nodal metastases.

References

1. Vertical tumor-positive resection margins and the risk of residual neoplasia after endoscopic resection of Barrett’s neoplasia: a nationwide cohort with pathology reassessment. Endoscopy (2024).
2. Machine learning to predict lymph node metastasis in T1 esophageal squamous cell carcinoma: a multicenter study. International Journal of Surgery (2024).
3. Analysis of metastases rates during follow-up after endoscopic resection of early “high-risk” esophageal adenocarcinoma. Gastrointestinal Endoscopy (2022).
4. Curative criteria for endoscopic treatment of oesophageal adenocarcinoma. Best Practice & Research Clinical Gastroenterology (2024).