{
  "abstract": "In response to Gupta and colleagues’ study on implementing an endoscopic submucosal dissection (ESD)-first algorithm for Barrett’s cancers >15 mm, we highlight critical concerns regarding selection bias, patient morbidity, and guideline adherence. We argue that the improved outcomes reported in the second study period may reflect a shift in case mix—diluted by morphologically favourable lesions—rather than the independent superiority of the strategy. Furthermore, from a risk–benefit perspective, the routine application of ESD exposes patients with dysplasia and T1a disease to a significantly higher risk of oesophageal strictures (22.6%) without demonstrating clear oncologic or survival superiority over endoscopic mucosal resection (EMR). We also raise concerns regarding the long-term oncological safety of patients with T1b diseasepatients who underwent non-curative resection without subsequent surgical salvage. Finally, we caution that lowering the ESD size threshold to 15 mm contradicts current international guidelines (typically >20 mm) and requires specific validation within this ‘“grey zone’.” We advocate for a more tailored approach that carefully balances oncologic clearance with the prevention of procedural morbidity.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastrointestinal Medical Oncology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China"
      ],
      "name": "Na Li"
    },
    {
      "affiliations": [
        "Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"
      ],
      "name": "Shuai Zhang"
    },
    {
      "affiliations": [
        "Department of Gastrointestinal Medical Oncology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China"
      ],
      "name": "Liqun Zhang"
    },
    {
      "affiliations": [
        "Department of Gynecologic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"
      ],
      "name": "Xiaohui Jiang"
    },
    {
      "affiliations": [
        "Radiology Department, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China"
      ],
      "name": "Xuejiao Fan"
    }
  ],
  "title": "Universal ESD for Barrett’s neoplasia: the T1b ‘“limbo’” and risk of overtreatment",
  "uid": "69ffff3c-54d2-5ba5-9f11-ec74495b94bf"
}