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Exploring non-curative endoscopic submucosal dissection: Current treatment optimization and future indication

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  • 1Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.

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Evaluating endoscopic submucosal dissection (ESD) quality is crucial for early gastric cancer. Management strategies for non-curative ESD cases, especially those with positive margins, require further research.

Keywords:
Early gastric cancerEndoscopic submucosal dissectionNear-infrared fluorescent tracerNon-curative endoscopic submucosal dissectionQuality control

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Medical Imaging

Background:

  • Endoscopic submucosal dissection (ESD) is increasingly used for early gastric cancer, necessitating robust quality assessment for curative resections.
  • Postoperative evaluation uses the endoscopic curability (eCura) classification, but management for eCuraC-1 tumors with positive horizontal margins remains undefined.
  • Existing research often compares surgical options for high-risk patients, with limited focus on specific eCuraC-1 scenarios.

Purpose of the Study:

  • To highlight the importance of ESD quality assessment for both curative and non-curative early gastric cancer resections.
  • To address the ambiguity in managing eCuraC-1 tumors with positive horizontal margins.
  • To explore the potential of molecular imaging in improving diagnosis and navigation for early gastric cancer.

Main Methods:

  • Review of current literature on ESD quality assessment and postoperative management strategies.
  • Analysis of the eCura classification system and its limitations.
  • Discussion of emerging technologies like molecular imaging with near-infrared fluorescent tracers.

Main Results:

  • The significance of comprehensive ESD quality evaluation, beyond just curative outcomes, is emphasized.
  • A knowledge gap exists regarding optimal management and follow-up for eCuraC-1 tumors with positive horizontal margins.
  • Molecular imaging presents a promising avenue for enhanced diagnostic precision and surgical navigation in early gastric cancer.

Conclusions:

  • Further research is essential to define management strategies and follow-up protocols for non-curative ESD cases, particularly eCuraC-1 with positive margins.
  • Advancements in molecular imaging could significantly improve the precision of tumor detection and navigation in endoscopic procedures.
  • Improving ESD efficacy and refining treatment indications are critical for better patient outcomes in early gastric cancer management.