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

Table 1 Conceptual summary of factors linking sarcopenia to post-endoscopic submucosal dissection esophageal stenosis

Domain	Key components	Mechanistic relevance	Clinical implications
Body composition	Reduced skeletal muscle mass; impaired muscle quality; increased intramuscular fat	Reflects decreased physiological reserve and impaired regenerative capacity	Identifies high-risk patients prior to ESD; supports pre-procedural risk stratification
Systemic inflammation	Chronic low-grade inflammation; cytokine imbalance; elevated inflammatory markers	Promotes profibrotic signaling and dysregulated wound healing	May justify closer monitoring and anti-inflammatory strategies
Nutritional status	Hypoalbuminemia; low prognostic nutritional index; malnutrition	Impairs collagen remodeling, epithelial repair, and tissue regeneration	Supports nutritional optimization before and after ESD
Myokine signaling	Reduced secretion of muscle-derived cytokines and growth factors	Alters angiogenesis, immune regulation, and fibrosis balance	Highlights systemic-muscle-organ crosstalk in mucosal healing
Fibrotic remodeling tendency	Excess extracellular matrix deposition; imbalance between regeneration and fibrosis	Favors stricture formation rather than adaptive healing	Explains increased susceptibility to esophageal stenosis
Interaction with procedural injury	Extensive mucosal defects; deep tissue injury; circumferential resection	Amplifies the impact of systemic frailty on local healing	Suggests combined evaluation of lesion and host factors
Aging and frailty overlap	Sarcopenia coexisting with age-related decline and comorbidities	Multifactorial impairment of healing pathways	Requires integrated geriatric and metabolic assessment
Predictive modeling potential	Integration of body composition with clinical variables	Improves discrimination beyond lesion-based models alone	Supports development of individualized risk prediction tools
Modifiability	Nutritional support; exercise-based prehabilitation; metabolic optimization	Potential to partially reverse sarcopenia-related vulnerability	Opens avenue for preventive intervention strategies
Clinical paradigm shift	From lesion-centered to patient-centered risk assessment	Emphasizes host-related determinants in endoscopic outcomes	Promotes personalized and holistic peri-procedural management

ESD: Endoscopic submucosal dissection.