Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2024; 30(9): 1257-1260
Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1257
Exploring non-curative endoscopic submucosal dissection: Current treatment optimization and future indication expansion
Yi-Nong Zhu, Xiang-Lei Yuan, Wei Liu, Yu-Hang Zhang, Yi Mou, Bing Hu, Lian-Song Ye
Yi-Nong Zhu, Xiang-Lei Yuan, Wei Liu, Yu-Hang Zhang, Yi Mou, Bing Hu, Lian-Song Ye, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhu YN and Yuan XL designed the article; Liu W write the manuscript; Zhang YH and Mou Y searched the lecture; Hu B and Ye LS revised the manuscript.
Supported by the China Postdoctoral Science Foundation, No. 2022M712265.
Conflict-of-interest statement: All authors disclosed no conflicts of interest.
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: Lian-Song Ye, MD, Doctor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 of Guoxue Alley, Chengdu 610041, Sichuan Province, China. yeliansongnj@wchscu.edu.cn
Received: December 18, 2023
Peer-review started: December 18, 2023
First decision: January 15, 2024
Revised: January 17, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 7, 2024
Abstract

The increasing popularity of endoscopic submucosal dissection (ESD) as a treatment for early gastric cancer has highlighted the importance of quality assessment in achieving curative resections. This article emphasizes the significance of evaluating ESD quality, not only for curative cases but also for non-curative ones. Postoperative assessment relies on the endoscopic curability (eCura) classification, but management strategies for eCuraC-1 tumour with a positive horizontal margin are unclear. Current research primarily focuses on comparing additional surgical procedures in high-risk patients, while studies specifically targeting eCuraC-1 patients are limited. Exploring management strategies and follow-up outcomes for such cases could provide valuable insights. Furthermore, the application of molecular imaging using near-infrared fluorescent tracers holds promise for precise tumour diagnosis and navigation, potentially impacting the management of early-stage gastric cancer patients. Advancing research in these areas is essential for improving the overall efficacy of endoscopic techniques and refining treatment indications.

Keywords: Early gastric cancer, Endoscopic submucosal dissection, Quality control, Non-curative endoscopic submucosal dissection, Near-infrared fluorescent tracer

Core Tip: The quality control of endoscopic submucosal dissection (ESD) has gained increasing attention, and concurrently, the management of patients with non-curative ESD outcomes is equally crucial. Existing guidelines offer unclear recommendations for the management of patients classified as endoscopic curability C-1 after the procedure, warranting the need for further clinical research to refine treatment strategies for this patient population.