Accuracy of endoscopic ultrasound for staging esophageal and gastroesophageal junction neoplasia prior to endoscopic submucosal dissection

BACKGROUND: Endoscopic submucosal dissection (ESD) is an established therapy for superficial esophageal lesions. Endoscopic ultrasound (EUS) is commonly used to assess submucosal invasion (SMI) and lymphadenopathy. METHOD: Retrospective cohort of patients with esophageal and gastroesophageal junction lesions undergoing EUS before ESD (2014-2025). EUS T stage was compared with final pathology to evaluate detection of SMI. RESULTS: = 7). CONCLUSION: EUS showed limited reliability for pre-ESD staging of esophageal/GEJ lesions, with suboptimal performance in detecting SMI. As depth of invasion determines therapeutic strategy, EUS should not be used in isolation but rather alongside expert endoscopic assessment and biopsy. ESD remains central by offering definitive treatment and precise histologic staging.