{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:57:03Z","timestamp":1781233023046,"version":"3.54.1"},"reference-count":86,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"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 resection (ER) has become the preferred curative-intent treatment for early upper gastrointestinal cancer, given its superior safety profile compared to surgery. Over the past decade, technological and procedural innovation has substantially expanded the scope, safety, and precision of endoscopic submucosal dissection (ESD) and related techniques. This review synthesises current evidence on key advances relevant to upper gastrointestinal ESD practice. Enhanced imaging modalities have improved lesion detection and characterisation, as well as recognition of intraoperative anatomical structures during third-space endoscopy. A new generation of therapeutic endoscopes combines high-definition optics with substantially improved tip-down angulation and channel size, addressing a longstanding gap between diagnostic-class image quality and procedural capability. Resection strategies\u2014including mechanical traction systems, saline immersion therapeutic endoscopy (SITE), and luminal drainage techniques\u2014have reduced procedural complexity and improved dissection conditions. Dedicated closure technologies have improved management of large resection defects, potentially reducing resection-related morbidity. Deep resection techniques, including submucosal tunnelling endoscopic resection (STER), device-assisted endoscopic full-thickness resection (FTRD), knife-assisted full-thickness resection (kFTR), and endoscopic intermuscular dissection (EID), are extending organ-preserving resection to deeply invasive cancers and subepithelial lesions. Management of non-curative ESD resections is being refined through multicentre risk stratification studies. Advances in simulation, competency-based training, and artificial intelligence hold promise for standardising technique acquisition and real-time procedural support. Together, these innovations are reshaping upper gastrointestinal oncology by positioning minimally invasive, organ-preserving digestive endoscopy as a central therapeutic strategy.<\/jats:p>","DOI":"10.3390\/jcm15124530","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:52:08Z","timestamp":1781229128000},"page":"4530","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Innovations in Advanced Endoscopic Resection of Early Upper Gastrointestinal Cancer"],"prefix":"10.3390","volume":"15","author":[{"given":"Andrea","family":"Sorge","sequence":"first","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy"},{"name":"Gastroenterology Unit, Azienda Ospedale-Universit\u00e0 Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3529-5040","authenticated-orcid":false,"given":"Pieter Jan","family":"Poortmans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Ghent, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"},{"name":"Department of Gastroenterology & Hepatology, University Hospital Brussels (UZ Brussels), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1484-5488","authenticated-orcid":false,"given":"Michele","family":"Montori","sequence":"additional","affiliation":[{"name":"Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Universit\u00e0 Politecnica delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-1494","authenticated-orcid":false,"given":"Maria Eva","family":"Argenziano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Ghent, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-2894","authenticated-orcid":false,"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy"},{"name":"Gastroenterology Unit, Azienda Ospedale-Universit\u00e0 Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-0434","authenticated-orcid":false,"given":"David J.","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Ghent, 9000 Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/den.12518","article-title":"Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer","volume":"28","author":"Ono","year":"2016","journal-title":"Dig. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1055\/a-1811-7025","article-title":"Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Update 2022","volume":"54","author":"Bastiaansen","year":"2022","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.4240\/wjgs.v13.i10.1180","article-title":"Gastric endoscopic submucosal dissection in Western countries: Indications, applications, efficacy and training perspective","volume":"13","author":"Mangiavillano","year":"2021","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.7326\/M19-2561","article-title":"Linked Color Imaging Focused on Neoplasm Detection in the Upper Gastrointestinal Tract: A Randomized Trial","volume":"174","author":"Ono","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1480651","DOI":"10.3389\/fonc.2024.1480651","article-title":"Diagnostic accuracy of linked color imaging and white light imaging for early gastric cancer and gastrointestinal metaplasia: A systematic review and meta-analysis","volume":"14","author":"Duan","year":"2024","journal-title":"Front. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.gie.2018.08.049","article-title":"Blue laser imaging-bright improves the real-time detection rate of early gastric cancer: A randomized controlled study","volume":"89","author":"Dohi","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.14309\/ajg.0000000000002871","article-title":"Comparison of Effective Imaging Modalities for Detecting Gastric Neoplasms: A Randomized 3-Arm Phase II Trial","volume":"119","author":"Kadota","year":"2024","journal-title":"Am. J. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1136\/gutjnl-2019-319631","article-title":"Early gastric cancer detection in high-risk patients: A multicentre randomised controlled trial on the effect of second-generation narrow band imaging","volume":"70","author":"Yoshida","year":"2021","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1200\/JCO.2009.25.4680","article-title":"Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: A multicenter randomized controlled trial","volume":"28","author":"Muto","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1038\/ajg.2009.426","article-title":"Narrow-band imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers","volume":"104","author":"Takenaka","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/den.12190","article-title":"Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology","volume":"26","author":"Neumann","year":"2014","journal-title":"Dig. Endosc."},{"key":"ref_12","first-page":"399","article-title":"The diagnostic capability of i-scan for early gastric cancer detection: A systematic review and meta-analysis","volume":"70","author":"Canakis","year":"2024","journal-title":"Minerva Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7884","DOI":"10.3748\/wjg.v21.i25.7884","article-title":"Diagnostic performance of magnifying narrow-band imaging for early gastric cancer: A meta-analysis","volume":"21","author":"Hu","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s10388-016-0527-7","article-title":"Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: Magnifying endoscopic classification of the Japan Esophageal Society","volume":"14","author":"Oyama","year":"2017","journal-title":"Esophagus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1055\/s-0029-1243949","article-title":"Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett\u2019s esophagus: A meta-analysis","volume":"42","author":"Mannath","year":"2010","journal-title":"Endoscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1055\/s-0029-1214594","article-title":"Magnifying endoscopy for diagnosing and delineating early gastric cancer","volume":"41","author":"Yao","year":"2009","journal-title":"Endoscopy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1111\/den.12638","article-title":"Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G)","volume":"28","author":"Muto","year":"2016","journal-title":"Dig. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Maselli, R., de Sire, R., Vadal\u00e0, V., Brandaleone, L., Poletti, V., Marcozzi, G., De Deo, D., Mercurio, M., Spertino, M., and Capogreco, A. (2026). Amber-red color imaging for enhanced anatomical structures recognition in third-space endoscopy: A prospective video-based study. Gastrointest. Endosc., in press.","DOI":"10.1016\/j.gie.2026.01.033"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1055\/s-0035-1569644","article-title":"Dual-focus versus conventional magnification endoscopy for the diagnosis of superficial squamous neoplasms in the pharynx and esophagus: A randomized trial","volume":"48","author":"Goda","year":"2016","journal-title":"Endoscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E441","DOI":"10.1055\/a-1759-2568","article-title":"Usefulness of optical enhancement endoscopy combined with magnification to improve detection of intestinal metaplasia in the stomach","volume":"10","author":"Emura","year":"2022","journal-title":"Endosc. Int. Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E872","DOI":"10.1055\/a-2106-0688","article-title":"Endoscopic submucosal dissection of gastric neoplasms with severe fibrosis using a new thin-therapeutic endoscope and a dedicated conical cap","volume":"55","author":"Miura","year":"2023","journal-title":"Endoscopy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s10388-025-01107-w","article-title":"Efficacy of a novel small-caliber therapeutic endoscope in peroral endoscopic myotomy for esophageal motility disorders: A propensity score matching analysis","volume":"22","author":"Abe","year":"2025","journal-title":"Esophagus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.vgie.2025.02.009","article-title":"Saline immersion endoscopic submucosal dissection for management of early Barrett\u2019s esophagus adenocarcinoma and large esophageal varices","volume":"10","author":"Bonura","year":"2025","journal-title":"VideoGIE"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"E1196","DOI":"10.1055\/a-2421-9676","article-title":"Nasogastric tube combined with thin therapeutic endoscope to facilitate esophageal endoscopic submucosal dissection","volume":"12","author":"Kowazaki","year":"2024","journal-title":"Endosc. Int. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.gie.2018.04.2331","article-title":"Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms (with video)","volume":"88","author":"Harada","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.dld.2017.08.035","article-title":"Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection","volume":"49","author":"Despott","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.vgie.2020.07.011","article-title":"Water-pocket endoscopic submucosal dissection of an early esophageal adenocarcinoma in a patient with portal hypertension and varices","volume":"5","author":"Dhaliwal","year":"2020","journal-title":"VideoGIE"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Dell\u2019Unto, E., Rimondi, A., Kalopitas, G., Bosch, E.M., Esposito, G., Yamamoto, H., Despott, E.J., and Murino, A. (2025). The saline-immersion\/irrigation technique (SITE) for colonic endoscopic submucosal dissection (ESD): A comprehensive evaluation of outcomes, efficacy, and safety. Saudi J. Gastroenterol., Online ahead of print.","DOI":"10.4103\/sjg.sjg_422_25"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.vgie.2025.11.005","article-title":"Set-up and use of the \u201cAsclepius tube\u201d: A slim drainage tube to facilitate saline-immersion endoscopic submucosal dissection","volume":"11","author":"Bosch","year":"2026","journal-title":"VideoGIE"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.vgie.2025.11.004","article-title":"The continuous low-pressure saline perfusion method of endoscopic submucosal dissection for the circumferential tumor in the remnant rectum after the Hartmann\u2019s procedure","volume":"11","author":"Hashimoto","year":"2026","journal-title":"VideoGIE"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E227","DOI":"10.1055\/s-0043-113556","article-title":"Water pressure method for duodenal endoscopic submucosal dissection","volume":"49","author":"Yahagi","year":"2017","journal-title":"Endoscopy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.vgie.2021.06.002","article-title":"Water pressure method overcomes the gravitational side in endoscopic submucosal dissection for gastric cancer","volume":"6","author":"Masunaga","year":"2021","journal-title":"VideoGIE"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.gie.2019.08.014","article-title":"Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: A multicenter, randomized controlled trial (with video)","volume":"91","author":"Yoshida","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.gie.2017.11.031","article-title":"Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: A multicenter, randomized controlled trial (with video)","volume":"87","author":"Yoshida","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1007\/s00464-021-08452-8","article-title":"Traction-assisted endoscopic submucosal dissection reduces procedure time and risk of serious adverse events: A systematic review and meta-analysis","volume":"36","author":"Lopimpisuth","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_36","first-page":"79","article-title":"Performance of three major techniques for endoscopic submucosal dissection: A systematic review and network meta-analysis","volume":"58","author":"Ramai","year":"2026","journal-title":"Endoscopy"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1055\/a-1106-3761","article-title":"Efficacy and safety of traction-assisted endoscopic submucosal dissection: A meta-regression of randomized clinical trials","volume":"52","author":"Su","year":"2020","journal-title":"Endoscopy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12876-021-02085-w","article-title":"Multi-loop traction device facilitates gastric endoscopic submucosal dissection: Ex vivo pilot study and an inaugural clinical experience","volume":"22","author":"Matsui","year":"2022","journal-title":"BMC Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"20050","DOI":"10.1038\/s41598-023-47390-4","article-title":"The efficacy and safety of multi-loop traction device for gastric endoscopic submucosal dissection: A single center prospective pilot study","volume":"13","author":"Kitahara","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E1013","DOI":"10.1055\/a-1904-7666","article-title":"Multipolar traction with adjustable force increases procedure speed during endoscopic submucosal dissection: The A-TRACT-4 traction device","volume":"54","author":"Grimaldi","year":"2022","journal-title":"Endoscopy"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.gie.2024.02.032","article-title":"Endoscopic submucosal dissection with adaptive traction strategy: First prospective multicenter study (with video)","volume":"100","author":"Grimaldi","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E778","DOI":"10.1055\/a-2387-3812","article-title":"Band-and-wire pulley traction: Endoscopic submucosal dissection of a gigantic gastric polyp aided by a novel adaptive traction technique","volume":"56","author":"Sorge","year":"2024","journal-title":"Endoscopy"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E699","DOI":"10.1055\/a-2615-5775","article-title":"Focal endoscopic intermuscular dissection guided by the pocket-detection method for radical excision of early T2 rectal cancer","volume":"57","author":"Sorge","year":"2025","journal-title":"Endoscopy"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E179","DOI":"10.1055\/a-2533-2996","article-title":"Traction-assisted and saline immersion endoscopic submucosal dissection for complete resection of peri-appendiceal large nonpedunculated colorectal polyps","volume":"57","author":"Montori","year":"2025","journal-title":"Endoscopy"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1016\/j.gie.2025.12.273","article-title":"Repositionable Elastic Adaptive Customizable Traction multipoint elastic traction for colorectal endoscopic submucosal dissection: A retrospective single-center feasibility series of 59 consecutive cases (with video)","volume":"103","author":"Poortmans","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1007\/s10620-025-09074-z","article-title":"Endoscopic Submucosal Dissection with Rubber Bands and Clips Compared to Conventional Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis","volume":"70","author":"Awad","year":"2025","journal-title":"Dig. Dis. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E416","DOI":"10.1055\/a-2801-5227","article-title":"First report of gastric muscle-retracting sign identification and endoscopic intermuscular dissection","volume":"58","author":"Sorge","year":"2026","journal-title":"Endoscopy"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1055\/a-2421-9767","article-title":"A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection","volume":"57","author":"Yoshida","year":"2025","journal-title":"Endoscopy"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"E1127","DOI":"10.1055\/a-2409-3622","article-title":"Clinical utility of a novel anchor pronged clip for mucosal defect closure after colorectal endoscopic submucosal dissection (with video)","volume":"12","author":"Shiomi","year":"2024","journal-title":"Endosc. Int. Open"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/den.14466","article-title":"Reopenable clip-over-the-line method for closing large mucosal defects following gastric endoscopic submucosal dissection: Prospective feasibility study","volume":"35","author":"Nomura","year":"2023","journal-title":"Dig. Endosc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"E1150","DOI":"10.1055\/a-2411-8724","article-title":"Endoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis","volume":"12","author":"Niu","year":"2024","journal-title":"Endosc. Int. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.igie.2024.09.007","article-title":"Efficacy and safety of over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: A systematic review and meta-analysis","volume":"3","author":"Vongsavath","year":"2024","journal-title":"iGIE"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.gie.2019.12.046","article-title":"Endoscopic hand-suturing is feasible, safe, and may reduce bleeding risk after gastric endoscopic submucosal dissection: A multicenter pilot study (with video)","volume":"91","author":"Goto","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gie.2024.08.001","article-title":"Feasibility of a new endoscopic suturing device: A first Western experience (with video)","volume":"101","author":"Scheppach","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.gie.2024.08.017","article-title":"Efficacy of different steroid therapies in preventing esophageal stricture after endoscopic submucosal dissection: A comparative meta-analysis","volume":"100","author":"Zhou","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1053\/j.gastro.2012.04.050","article-title":"Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets","volume":"143","author":"Ohki","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"E132","DOI":"10.1055\/a-2233-2914","article-title":"First report of gastric endoscopic intermuscular dissection","volume":"56","author":"Despott","year":"2024","journal-title":"Endoscopy"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/a-2369-7854","article-title":"A subepithelial lesion algorithm for endoscopic (SAFE) resection in the upper gastrointestinal tract","volume":"57","author":"Gupta","year":"2025","journal-title":"Endoscopy"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"E246","DOI":"10.1055\/s-0034-1391665","article-title":"Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection","volume":"3","author":"Toyonaga","year":"2015","journal-title":"Endosc. Int. Open"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3121","DOI":"10.1007\/s00464-015-4567-1","article-title":"Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer","volume":"30","author":"Tan","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/SLA.0000000000001650","article-title":"Long-term Outcomes of Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors","volume":"265","author":"Chen","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.igie.2023.08.005","article-title":"Efficacy and safety of submucosal tunneling endoscopic resection for subepithelial tumors in the upper GI tract: A systematic review and meta-analysis of >2900 patients","volume":"2","author":"Tun","year":"2023","journal-title":"iGIE"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"E1291","DOI":"10.1055\/a-1216-1439","article-title":"Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: The first international experience","volume":"8","author":"Hajifathalian","year":"2020","journal-title":"Endosc. Int. Open"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1007\/s00464-019-07269-w","article-title":"Endoscopic full-thickness resection of duodenal lesions (with video)","volume":"34","author":"Andrisani","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2926","DOI":"10.1007\/s00464-011-1644-y","article-title":"Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria","volume":"25","author":"Zhou","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1055\/a-2632-4341","article-title":"Diagnostic accuracy of the muscle-retracting sign for determining deep submucosal invasion in early rectal cancer: A prospective observational study","volume":"57","author":"Argenziano","year":"2025","journal-title":"Endoscopy"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e70116","DOI":"10.1002\/deo2.70116","article-title":"Knife-assisted full-thickness resection guided by the pocket-detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video)","volume":"5","author":"Argenziano","year":"2025","journal-title":"DEN Open"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1111\/den.15082","article-title":"Risk of Metastasis and Local Residual Cancer After Non-Curative Endoscopic Submucosal Dissection for Esophageal Cancer","volume":"37","author":"Ishihara","year":"2025","journal-title":"Dig. Endosc."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/a-1399-4989","article-title":"Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: A multicenter cohort study","volume":"54","author":"Gotink","year":"2022","journal-title":"Endoscopy"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00535-024-02189-6","article-title":"Comprehensive pathological evaluation of risk factors for metastasis after endoscopic resection of superficial esophageal squamous cell carcinoma","volume":"60","author":"Ishihara","year":"2025","journal-title":"J. Gastroenterol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1007\/s00464-023-10623-8","article-title":"Esophagectomy versus observation following endoscopic submucosal dissection of pT1b esophageal adenocarcinoma","volume":"38","author":"Tankel","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1055\/a-2538-9316","article-title":"Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: An international multicenter retrospective cohort study","volume":"57","author":"Chan","year":"2025","journal-title":"Endoscopy"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1038\/ajg.2017.95","article-title":"A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early Gastric Cancer: \u201ceCura system\u201d","volume":"112","author":"Hatta","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"S438","DOI":"10.1016\/j.gie.2025.03.785","article-title":"Low Recurrence Rates After Endoscopic Resection (R0) of High-Risk T1 Adenocarcinoma in Barrett Esophagus Support a Strict Endoscopic Surveillance Strategy: Preliminary Results of a Prospective, International, Multicenter Cohort Study (PREFER)","volume":"101","author":"Bos","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1186\/s13063-020-04461-5","article-title":"Esophagectomy versus definitive chemoradiotherapy for patients with clinical stage N0 and pathological stage T1b esophageal squamous cell carcinoma after endoscopic submucosal dissection: Study protocol for a multicenter randomized controlled trial (Ad-ESD Trial)","volume":"21","author":"Yang","year":"2020","journal-title":"Trials"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Japanese Gastric Cancer Association (2026). Japanese gastric cancer treatment guidelines 2025 (7th edition). Gastric Cancer, 29, 271\u2013299.","DOI":"10.1007\/s10120-025-01698-4"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10388-023-00993-2","article-title":"Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: Part 1","volume":"20","author":"Kitagawa","year":"2023","journal-title":"Esophagus"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"3614","DOI":"10.1007\/s00464-016-5393-9","article-title":"Learning curve and clinical outcome of gastric endoscopic submucosal dissection performed by trainee operators","volume":"31","author":"Yoshida","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1007\/s00464-018-6397-4","article-title":"Defining competencies for endoscopic submucosal dissection (ESD) for gastric neoplasms","volume":"33","author":"Takao","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1055\/a-0996-0912","article-title":"Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement","volume":"51","author":"Pioche","year":"2019","journal-title":"Endoscopy"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.3748\/wjg.v16.i23.2895","article-title":"Endoscopic submucosal dissection training with pig models in a Western country","volume":"16","author":"Arnau","year":"2010","journal-title":"World J. Gastroenterol. WJG"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.gie.2023.10.051","article-title":"Untutored training pathway to achieve competence in esophagogastric endoscopic submucosal dissection in a Western center","volume":"99","author":"Hadjinicolaou","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1055\/a-2569-7736","article-title":"Simulators and training models for diagnostic and therapeutic gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review","volume":"57","author":"Coluccio","year":"2025","journal-title":"Endoscopy"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.gie.2023.12.037","article-title":"Automated artificial intelligence-based phase-recognition system for esophageal endoscopic submucosal dissection (with video)","volume":"99","author":"Furube","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1055\/a-2534-1164","article-title":"Use of artificial intelligence in submucosal vessel detection during third-space endoscopy","volume":"57","author":"Scheppach","year":"2025","journal-title":"Endoscopy"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1055\/a-2699-5861","article-title":"Safety and efficacy of traction robot-assisted endoscopic submucosal dissection for early gastric cancer: A randomized pilot trial","volume":"58","author":"Zhang","year":"2026","journal-title":"Endoscopy"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4530\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:17:46Z","timestamp":1781230666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":86,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124530"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124530","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}