Advances in endoscopic strategies for oesophageal squamous cell carcinoma

Endoscopic management of early oesophageal squamous cell carcinoma (ESCC) is progressively moving from a binary curative versus non-curative approach towards a risk-adapted strategy. Accurate optical assessment remains essential, but its limitations support the use of endoscopic resection, particularly endoscopic submucosal dissection (ESD), as both a therapeutic and a staging procedure. Compared with endoscopic mucosal resection, ESD provides higher en-bloc and complete resection rates, better histological assessment and lower local recurrence, although it requires dedicated expertise. Post-resection management should integrate depth of invasion, lymphovascular invasion, differentiation, margin status, comorbidities and patient preferences. Circumferential lesions represent a specific challenge because of the important risk of refractory stenosis. Definitive chemoradiotherapy remains a major organ-preserving option, either after non-curative ESD or as primary treatment, while salvage endoscopic therapy may be considered for selected superficial local failures. Multidisciplinary discussion is therefore central to balance oncological control, treatment morbidity and quality of life.