Clinical features of early esophageal neoplastic lesions at different stages and efficacy and prognosis after endoscopic submucosal dissection.

BACKGROUND: Esophageal cancer is a common malignancy, and endoscopic submucosal dissection (ESD) is the treatment of choice for early esophageal cancer. AIM: To analyze clinicopathological features, ESD efficacy, and prognostic factors of differentiated esophageal neoplasms to optimize management strategies. METHODS: A total of 264 Lesions in 245 patients treated with ESD (2014-2022) were retrospectively analyzed. Lesions were categorized as low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early-stage carcinoma, or superficial carcinoma. Clinicopathological data and outcomes were compared. RESULTS: Early-stage cancers showed more surface vesicles than LGIN (P = 0.002). Intraepithelial papillary capillary loop (IPCL)-A predominated in LGIN, while IPCL-B2 was frequent in cancer (P < 0.001). Superficial carcinomas had higher vertical margin positivity (P < 0.001). Curative resection correlated with differentiation, body mass index (BMI), and symptoms; complications were linked to gender, BMI, and lesion size. The 3-, 5-, and 8-year disease-free survival rates were 96.8%, 91.7%, and 86.4%, respectively. Age [hazard ratio (HR) = 1.018] and prior esophageal cancer (HR = 3.050) predicted poorer survival. CONCLUSION: Differentiated esophageal neoplasms exhibit distinct clinicopathological features. ESD provides durable efficacy, but high-risk patients (older age, prior cancer) require vigilant surveillance.