Abstract
PURPOSE OF REVIEW: Endoscopic resection (ER) has transformed the management of early gastrointestinal (GI) malignancies by offering curative treatment with low morbidity and organ preservation. Traditionally restricted to mucosal disease with negligible risk of lymph node metastasis (LNM), recent advances in technique and risk stratification have prompted a re-evaluation of ER indications for esophageal, gastric, and colorectal cancers. This review summarizes the oncologic rationale, current evidence, and emerging technologies supporting the safe expansion of ER indications across GI malignancies. RECENT FINDING: s: Refined histopathologic criteria, enhanced en-bloc resection through endoscopic submucosal dissection, and the introduction of endoscopic full-thickness resection have expanded curative resection to select early GI malignancies previously considered surgical. Clinical outcomes from large series demonstrate comparable long-term survival to surgery when rigorous selection and surveillance criteria are applied, while minimizing morbidity. Molecular biomarkers, artificial intelligence (AI)-based predictive models, and sentinel node mapping are promising tools to further improve risk assessment for occult LNM. Expansion of ER indications for early GI cancers is feasible and increasingly practiced in expert centers with outcomes approximating those of surgical resection. Ongoing integration of precision diagnostics, molecular profiling, and AI-driven risk models promises to further refine patient selection. However, widespread adoption should proceed within structured, evidence-based frameworks to prevent undertreatment of potentially curable disease and maintain oncologic integrity.