Endoscopic and surgical management of early esophageal cancer: Current evidence and evolving oncologic strategies

Figure 1 Endoscopic submucosal dissection for esophageal cancer resection. A: Iodophor staining of the lesion; B: Cauterization marking around the lesion and submucosal injection; C: Use duel knife to cut the mucosa around the lesion; D: Gradually separate the lesion from the muscularis propria by electric resection; E: Wound site after electrocoagulation hemostasis; F: Removed lesion specimen.

Figure 2 Treatment algorithm for early esophageal cancer. Patients with suspected early esophageal neoplasia undergo diagnostic endoscopy with biopsy and staging evaluation, including endoscopic ultrasound when appropriate. Low-risk mucosal lesions (T1a), without adverse histologic features, are treated with endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection, followed by adjunctive ablative therapy and endoscopic surveillance as indicated. High-risk lesions or non-curative resections require multidisciplinary evaluation and consideration of esophagectomy, with or without chemoradiotherapy, or definitive oncologic therapy. APC: Argon plasma coagulation; EUS: Endoscopic ultrasound; LVI: Lymphovascular invasion; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; RFA: Radiofrequency ablation.