Principles of Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) remains a major global health burden, particularly in East and Southeast Asia, where incidence rates are highest. Early-stage ESCC represents a critical therapeutic window in which curative treatment can be achieved using minimally invasive, organ-preserving approaches. Advances in endoscopic imaging, including narrow-band imaging, magnifying endoscopy, chromoendoscopy, and emerging modalities such as endocytoscopy and artificial intelligence–assisted detection, have substantially improved the accuracy of early diagnosis and invasion depth assessment. According to current staging systems, including the AJCC/UICC classification, endoscopic resection is an established curative treatment for carefully selected patients with mucosal ESCC. Endoscopic submucosal dissection has become the preferred technique owing to its high en bloc and R0 resection rates. This narrative review summarizes contemporary strategies for endoscopic diagnosis, patient selection, resection techniques, pathological assessment, surveillance, and future directions in the management of early ESCC.