Universal submucosal dissection outperforms selective mucosal resection in early esophageal adenocarcinoma

Younis F, Rösch T, Anders M, Ehlken H, Zimmermann-Fraedrich K, Dautel P, Clauditz T, Vieth M, de Heer J, Werner Y, Ruppenthal T, Shibolet O, Mann O, Cataldegirmen G, Sehner S, Bourke MJ, Schachschal G (2026)

Publication Type: Journal article, Review article

Publication year: 2026

Journal

Endoscopy Thieme Publishing / Georg Thieme Verlag

Pages Range: 275-279

DOI: 10.1055/a-2767-6165

Abstract

Background In early esophageal adenocarcinoma (EAC), guidelines recommend endoscopic mucosal resection (EMR) for superficial (T1a) lesions and endoscopic submucosal dissection (ESD) for deeper (T1b) lesions based on visual assessment. We evaluated the outcomes of this targeted resection strategy. Methods In a retrospective bicentric study (2009–2023), 311 T1 EACs (235 T1a, 76 T1b) underwent endoscopic resection: EMR for presumed T1a and ESD for suspected T1b lesions. The primary outcome was complete (R0) resection stratified by tumor stage and resection technique. Secondary outcomes were rates of curative resection, adverse events, and surgery. Results EMR was appropriately applied in 63.0% of T1a cases, and ESD was correctly selected in 60.5% of T1b cases. R0 resection rates were higher with ESD than with EMR for both stages: T1a, 92.9% vs. 80.4%; T1b, 63.0% vs. 26.7%. Curative resection (ESD 60.9% vs. EMR 67.4%), surgery (19.5% vs. 14.0%), and adverse events (7.5% vs. 10.1%) were comparable. On multivariable analysis, ESD was the only independent predictor of complete resection. If surgery decisions had been based on R0 rather than curative outcomes, 20% of post-EMR and 50% of post-ESD esophagectomies could have been avoided Conclusions Endoscopic staging of early EAC is imperfect, leading to frequent mismatch between chosen and optimal resection techniques. ESD achieved higher complete resection rates for both T1a and T1b cancers without increased morbidity. ESD may therefore represent the preferred strategy for early EAC, potentially reducing unnecessary surgery.

Authors with CRIS profile

Michael Vieth Professur für Allgemeine Pathologie am Medizincampus Oberfranken

Involved external institutions

Tel Aviv University IL Israel (IL) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) Vivantes Klinikum Berlin Spandau DE Germany (DE) Westmead Hospital AU Australia (AU)

How to cite

APA:

Younis, F., Rösch, T., Anders, M., Ehlken, H., Zimmermann-Fraedrich, K., Dautel, P.,... Schachschal, G. (2026). Universal submucosal dissection outperforms selective mucosal resection in early esophageal adenocarcinoma. Endoscopy, 275-279. https://doi.org/10.1055/a-2767-6165

MLA:

Younis, Fadi, et al. "Universal submucosal dissection outperforms selective mucosal resection in early esophageal adenocarcinoma." Endoscopy (2026): 275-279.

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