Abstract:Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of Siewert type Ⅱ early adenocarcinoma of the esophagogastric junction (AEG) and esophagogastric junction (EGJ) precancerous lesions. Methods The clinical data, endoscopic features, postoperative pathology, intraoperative and postoperative complications and follow-up results of 41 patients with Siewert type Ⅱ early AEG and EGJ precancerous lesions in the Department of Gastroenterology of Nanjing Jiangning Hospital from April 2020 to February 2024 were analyzed retrospectively. Results The success rate of ESD operation was 100%, the complete resection rate of the lesion was 97.6%, the curative resection rate was 73.2%, the coincidence rate of endoscopic and pathological infiltration was 92.7%, and the postoperative pathological upgrade rate was 68.3%. The intraoperative complication rate was 14.6%, with 5 cases showing exposure of the local muscle layer or damage to the superficial muscle layer, and 1 case showing local submucosal fibrosis adhesion with significant bleeding. The postoperative complication rate was 9.8%, with 1 case of splenic rupture, 1 case of delayed postoperative bleeding, and 2 cases of postoperative cardiac stenosis, all of which improved after symptomatic treatment. Follow-up ranged from 2 to 44 months, with a postoperative recurrence rate of 2.3% and an all-cause mortality rate of 7.3%. Conclusion ESD is a minimally invasive, safe and effective endoscopic treatment for early Siewert type Ⅱ AEG and EGJ precancerous lesions, with high complete resection rate and curative resection rate, fewer postoperative complications and no serious adverse event.