Beyond local injury: Sarcopenia as a systemic host-related determinant of esophageal stenosis after endoscopic submucosal dissection

doi:10.3748/wjg.118801

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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 Gastroenterol. Sep 14, 2026; 32(34): 118801
Published online Sep 14, 2026. doi: 10.3748/wjg.118801

Beyond local injury: Sarcopenia as a systemic host-related determinant of esophageal stenosis after endoscopic submucosal dissection

Wen-Mao Li, Bo Liu, Qing Liu

Wen-Mao Li, Department of Rehabilitation, The Second Hospital of Jilin University, Changchun 130000, Jilin Province, China

Bo Liu, Department of Cadre’s Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China

Qing Liu, Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin Province, China

Co-corresponding authors: Bo Liu and Qing Liu.

Author contributions: Li WM contributed to conceptualization, literature synthesis, and drafting of the manuscript; Liu B contributed to the study design, critical revision of the intellectual content, and supervision; Liu Q contributed to conceptual framework development, manuscript revision, and final approval of the version to be published. Liu B and Liu Q supervised the academic development of the manuscript and provided substantial intellectual input during revision and finalization. In view of their shared responsibility for the scientific oversight, critical revision, and final approval of the manuscript, they were designated as co-corresponding authors. All authors have read and approved the final manuscript. Regarding the designation of co-corresponding authors, Liu B and Liu Q both contributed substantially to the academic supervision, conceptual development, and critical revision of the manuscript, and jointly approved the final version. Therefore, they were designated as co-corresponding authors.

AI contribution statement: ChatGPT was used solely for language polishing and writing assistance to improve the clarity and readability of the manuscript. No part of the main text, including the Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion, was generated by artificial intelligence. No AI tools were involved in the study design, data analysis, interpretation of results, or generation of images. All scientific content and conclusions were independently developed and approved by the authors, who take full responsibility for the integrity and originality of the manuscript.

Conflict-of-interest statement: There is no conflict of interest.

Corresponding author: Bo Liu, Assistant Professor, Department of Cadre’s Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Xinmin Street, Changchun 130021, Jilin Province, China. liubo_tengzhou@jlu.edu.cn

Received: January 12, 2026
Revised: February 21, 2026
Accepted: March 10, 2026
Published online: September 14, 2026
Processing time: 220 Days and 1.8 Hours

Abstract

Esophageal stenosis remains a clinically significant complication after endoscopic submucosal dissection (ESD), traditionally attributed to local factors such as mucosal defect size, circumferential involvement, and postoperative inflammation. However, growing evidence suggests that patient-related systemic conditions may play an underappreciated role in post-ESD healing outcomes. Recent retrospective observational data identifying computed tomography-defined sarcopenia as an independent predictor of esophageal stenosis suggest a challenge to the lesion-centered paradigm that has dominated risk assessment strategies. By integrating sarcopenia into a postoperative risk prediction model, this review highlights the importance of body composition and nutritional reserve in modulating tissue repair and fibrosis following endoscopic intervention. From a gastroenterology perspective, these findings have important clinical implications. They suggest that the risk of post-ESD stenosis may be influenced not only by what is resected, but also by who the patient is at the time of intervention. Early identification of sarcopenia could enable preemptive nutritional optimization, closer surveillance, and individualized preventive strategies. Recognizing sarcopenia as a host-related determinant systemic determinant of endoscopic outcomes may refine peri-procedural risk stratification and represents a step toward more holistic management of patients undergoing therapeutic endoscopy.

Keywords: Sarcopenia; Endoscopic submucosal dissection; Esophageal stenosis; Body composition; Wound healing; Fibrosis; Nutritional status; Risk stratification

Core Tip: Esophageal stenosis after endoscopic submucosal dissection has traditionally been regarded as a consequence of local mucosal injury. Emerging evidence indicates that sarcopenia, a systemic condition reflecting impaired nutritional reserve, inflammation, and reduced regenerative capacity, is independently associated with adverse post-endoscopic submucosal dissection outcomes. Recognizing sarcopenia as a host-related determinant of esophageal healing shifts risk assessment beyond lesion characteristics alone and supports more holistic peri-procedural management strategies.