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. Nov 21, 2026; 32(43): 120660
Published online Nov 21, 2026. doi: 10.3748/wjg.120660
Endoscopic diagnosis and treatment of early gastric cardia neoplasms: Efficacy and management of non-curative resection
Ning Zhu, Meng-Yao Chen, Ke-Qing Li, Fang-Lan Li, Bin Qin, Jiong Jiang, Shen-Hao Wang, Jie Wu, Wen-Tao Xi, Shi-Yuan Liu, Yi-He Li, Bai-Cang Zou
Ning Zhu, Meng-Yao Chen, Ke-Qing Li, Bin Qin, Jiong Jiang, Shen-Hao Wang, Yi-He Li, Bai-Cang Zou, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Fang-Lan Li, Department of Gastroenterology, Xianyang Hospital of Yan’an University, Xianyang 712000, Shaanxi Province, China
Jie Wu, Department of Pathology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Wen-Tao Xi, Department of Medical Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Shi-Yuan Liu, Department of Thoracic Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Co-first authors: Ning Zhu and Meng-Yao Chen.
Author contributions: Zhu N and Chen MY analyzed the research data and drafted the manuscript as co-first authors; Zhu N, Chen MY, Li KQ, Li FL, and Li YH collected and collated the clinical and pathological data of the research subjects; Zhu N and Zou BC designed the research and formulated the research hypothesis; Wu J completed the pathological diagnosis and evaluation of lesions and provided pathological analysis results; Xi WT conducted oncological professional evaluation and follow-up guidance for the research subjects; Liu SY provided professional thoracic surgery suggestions for the research and participated in the discussion of treatment plans; Zou BC revised and polished the manuscript and guided the entire research process; All authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University, No. 2025-156.
Informed consent statement: The informed consent statement has been exempted.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Bai-Cang Zou, PhD, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 West Fifth Road, Xi’an 710004, Shaanxi Province, China.
zoubaicang2@163.com
Received: March 6, 2026
Revised: March 20, 2026
Accepted: April 21, 2026
Published online: November 21, 2026
Processing time: 206 Days and 9.9 Hours
BACKGROUND
Gastric cardia cancer is a distinct clinicopathological entity with an increasing global incidence. Because of its location at the esophagogastric junction and complex submucosal architecture, early gastric cardia neoplasms pose significant challenges for accurate endoscopic diagnosis and depth assessment. These difficulties may lead to pathological underestimation and high rates of noncurative resection (NCR) after endoscopic submucosal dissection (ESD). Although additional surgery is generally recommended for NCR, this strategy may lead to overtreatment in selected low-risk patients. Therefore, evaluating the diagnostic performance of endoscopic modalities and exploring individualized management strategies after ESD are important clinically.
AIM
To evaluate ESD efficacy and safety for early gastric cardia neoplasms and explore individualized management for patients undergoing NCR.
METHODS
We retrospectively analyzed 155 patients with 163 early gastric cardia mucosal lesions treated by ESD between March 2014 and June 2025. Diagnostic accuracy of white-light endoscopy, magnifying endoscopy with narrow-band imaging, and endoscopic ultrasonography was evaluated using postoperative pathology as the reference standard. ESD outcomes, management of NCR, and long-term survival were assessed. Logistic regression identified factors associated with NCR, and survival was analyzed using Kaplan-Meier and Cox models.
RESULTS
Most lesions were classified as E = G type (Nishi classification) and located on the posterior wall of the cardia. White-light endoscopy showed a diagnostic accuracy of 70.6% (κ = 0.21), compared with 84.3% (κ = 0.54) for magnifying endoscopy with narrow-band imaging. Endoscopic ultrasonography demonstrated an accuracy of 69.5% (κ = 0.12) for assessing invasion depth. All lesions were removed en bloc; histologically complete resection was achieved in 82.8% of cases, and 73.0% met the e-Cura criteria for curative resection. Complications were rare (bleeding 1.8%). The 5-year overall survival and disease-free survival rates were 97.0% and 94.5%, respectively. Of the 44 patients with NCR (27.0%), 7 underwent additional surgery (with no residual tumor or nodal metastasis found) and 37 opted for surveillance. The 5-year disease-free survival was 85.7% in the surgery group and 93.5% in the surveillance group.
CONCLUSION
ESD is effective for early gastric cardia neoplasms. Individualized surveillance for low-risk NCR patients helps reduce overtreatment and improve clinical prognosis.
Core Tip: Endoscopic submucosal dissection is safe and effective for early gastric cardia cancer. Magnifying endoscopy with narrow-band imaging has superior diagnostic accuracy compared with white-light endoscopy (84.3% vs 70.6%). Despite a 27.0% noncurative resection rate due to the anatomical complexity of the cardia, selected low-risk noncurative resection patients can be safely managed with strict endoscopic surveillance.
