Real-World Validation of Guideline-Defined Curative Criteria After Endoscopic Submucosal Dissection for Early Gastrointestinal Cancers: An Indian Experience

Aims and Background: Endoscopic submucosal dissection (ESD) is an effective alternative to surgery for early gastrointestinal (GI) cancers. Curative and non-curative ESD criteria are primarily derived from high-volume centres within structured screening programs, where pathological assessment guides post-resection management. However, real-world validation of these criteria in routine clinical practice, particularly in centres with evolving ESD expertise, remains limited. We evaluated outcomes of ESD-treated early GI cancers using standard guideline-defined curative criteria in a tertiary-care centre in India. Methods: This retrospective descriptive study included patients with early epithelial GI cancers (pTis–pT1) treated by ESD a tertiary care centre. Resected specimens were processed using International Collaboration on Cancer Reporting datasets and classified as curative or non-curative according to European Society of Gastrointestinal Endoscopy and Japan Gastroenterological Endoscopy Society criteria. Clinical outcomes, additional therapy, follow-up status analysed. Results: Seventeen early GI cancers underwent ESD, with en-bloc resection achieved in 88%. After excluding two indeterminate resections, curative ESD was achieved in 60% (9/15). Median follow-up was 18 months (range 6–36 months). All patients with curative ESD remained disease-free without additional therapy. Non-curative ESD occurred in 40% (6/15), leading to additional surgery or locoregional therapy in 29% (5/17). Residual tumour was identified in three patients, and lymph node metastasis was detected in one patient despite absence of residual primary tumour. Conclusions: Application of standard guideline-based curative criteria in routine Indian clinical practice reliably predicted outcomes and guided post-resection management, supporting the generalizability of established ESD decision frameworks beyond expert screening-based settings.