{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:42:10Z","timestamp":1790984530334,"version":"4.1.0"},"reference-count":80,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Endoscopic submucosal dissection (ESD) has revolutionized the management of early upper gastrointestinal (GI) carcinomas. While technically demanding, it offers, in experienced hands, definitive local therapy for early GI neoplasia by allowing complete En bloc resection of mucosal and superficially invasive neoplasms, thus enabling precise histopathological risk stratification and organ preservation. Appropriate patient selection relies on meticulous endoscopic assessment using high-definition and image-enhanced endoscopy to define lesion boundaries and predict invasion depth. The principal indications include high-grade intraepithelial neoplasia and early carcinomas without endoscopic evidence of deep submucosal invasion or lymph node metastasis risk factors. Pathological analysis of the resection specimens includes histological typing and grading per WHO classification and precise assessment of invasion depth\u2014in case of submucosal invasion measurement in micrometers\u2014and evaluation of margin status and lymphovascular invasion. The presence of risk factors such as deep invasion in the submucosa, poor differentiation, or lymphovascular invasion may require additional surgery, guided by validated risk scores such as the eCura system. This narrative review summarizes current clinical and pathological practices for ESD in upper GI lesions. This includes the discussion of technical and biological challenges and the need of accurate assessment of risk factors for systemic metastatic spread and local recurrence as a limitation for this sophisticated but highly effective therapeutic method.<\/jats:p>","DOI":"10.3390\/jcm14248817","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T15:27:20Z","timestamp":1765553240000},"page":"8817","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic Submucosal Dissection (ESD) of Upper Gastrointestinal Carcinomas: An Integrated Clinical and Pathological Perspective"],"prefix":"10.3390","volume":"14","author":[{"given":"Alexander","family":"Ziachehabi","sequence":"first","affiliation":[{"name":"Department for Internal Medicine 4, Ordensklinikum Linz-Barmherzige Schwestern, 4020 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Worm","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology, Johannes Kepler University Linz, 4021 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drolaiz H. W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology, Johannes Kepler University Linz, 4021 Linz, Austria"},{"name":"Kepler University Hospital GmbH, 4021 Linz, Austria"},{"name":"Department of Pathology, GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Pimingstorfer","sequence":"additional","affiliation":[{"name":"Kepler University Hospital GmbH, 4021 Linz, Austria"},{"name":"University Clinic for Internal Medicine 2, Johannes Kepler University Linz, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert","family":"Langer","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology, Johannes Kepler University Linz, 4021 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"693","DOI":"10.3748\/wjg.v28.i7.693","article-title":"Early gastric cancer: A challenge in Western countries","volume":"28","author":"Chiarello","year":"2022","journal-title":"World J. 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