Risk factors and prediction model for submucosal invasion in early protruding-type esophagogastric junction adenocarcinoma - conventional endoscopy combines with endoscopic ultrasonography

Q: What clinical problem does the study address?

Accurate preoperative depth evaluation of protruding-type early esophagogastric junction adenocarcinoma is difficult, and diagnostic uncertainty can lead to inappropriate treatment choices. The study aims to improve identification of SM2 (submucosal-invasive) disease.

Q: How were CE and EUS used in the study?

The study retrospectively assessed conventional endoscopy macroscopic morphology, EUS diagnostic accuracy, and clinicopathological correlations. Multivariate analysis identified predictors of SM2 invasion and informed a predictive nomogram.

Q: What improves diagnostic performance for low-confidence CE-SM2 lesions?

For CE-SM2 low-confidence lesions, adding EUS showed a higher diagnostic yield compared with CE alone (41.7% vs. 24.0%).

Sep 30, 2026

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Precise depth assessment of protruding-type early esophagogastric junction adenocarcinoma is essential for therapy planning. This retrospective study evaluated conventional endoscopy and endoscopic ultrasonography to identify suspected submucosal-invasive carcinomas and to build a predictive model for SM2 invasion in 111 patients (2015–2024). A nomogram integrating CE morphology, air-induced changes, GERD history, EUS findings, and submucosal cystic echoes achieved ROC AUC 0.843, with calibration supporting clinical use and improved diagnostic yield in CE-SM2 low-confidence lesions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background

Methods

Results

Conclusions

Introduction

Zhang et al. BMCGastroenterology (2026) 26:10 [https://doi.org/10.1186/s12876-025-04501-x](https://doi.org/10.1186/s12876-025-04501-x) BMC Gastroenterology RESEARCH Open Access Risk factors and prediction model for submucosal invasion in early protruding-type esophagogastric junction adenocarcinoma: conventional endoscopy combines with endoscopic ultrasonography Lei Zhang 1, Nana An 1, Zhongfei Jia2, Xiuli Zheng 1, Wenqian Ma 1, Juntao Lu3 and Limian Er 1* Abstract Background Precise depth evaluation of protruding-type early esophagogastric junction adenocarcinoma (EGJAC) is critical for therapeutic planning. This study evaluated the diagnostic value of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) for identifying suspected submucosal-invasive carcinomas and established a predictive model for SM2 invasion. Methods A retrospective analysis included 111 patients with protruding-type EGJAC (2015–2024) . CE macroscopic morphology, EUS diagnostic accuracy, and clinicopathological correlations were systematically assessed. multivariate analysis identified SM2 predictors. Construct a predictive nomogram for SM2-invading protruding-type early EGJAC incorporating CE macroscopic morphology, air-induced morphological changes, gastroesophageal reflux disease (GERD), EUS-verified, and submucosal cystic echoes. The predictive accuracy of the nomogram was evaluated through receiver operating characteristic (ROC) curve analysis and calibration validation. Results CE and EUS showed comparable overall diagnostic accuracy (65 . 7% vs. 69. 3%) . A numerical improvement in diagnostic yield was observed with EUS for CE-SM2 low-confidence lesions (41 . 7% vs. 24. 0%) . CE-SM2 lowconfidence lesions demonstrated both significantly elevated GERD co-occurrence rates (56 . 0% vs. 13. 8%; P = 0 . 038) and predominant abrupt elevation without depression morphology (AEw/oD: 64 . 0%), contrasting with abrupt elevation with depression morphology (AEwD: 71.4%) in high-confidence counterparts (P < 0. 001) . Multivariate analysis identified AEwD (OR = 8 . 57, 95% CI: 1.29–56. 81) and absence of submucosal cystic echoes (OR = 6 . 97, 95% CI: 1.84–26. 37) as independent SM2 predictors. The nomogram model for predicting SM2 invasion showed an area under the receiver operating characteristic (ROC) curve of 0.843 (95% CI: 0 .732–0. 954) . Conclusions A validated predictive model has been developed to identify SM2 invasion in protruding-type early EGJAC. This predictive tool additionally facilitates optimal treatment selection guidance for patients with protruding- *Correspondence: Limian Er[njkelm@163.com](njkelm@163.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Zhang et al. BMC Gastroenterology (2026) 26:10 Page 2 of 11 type early EGJAC. In addition, accurate assessment of CE-SM2 low-confidence invasion in protruding-type early

FAQs

What clinical problem does the study address?

Accurate preoperative depth evaluation of protruding-type early esophagogastric junction adenocarcinoma is difficult, and diagnostic uncertainty can lead to inappropriate treatment choices. The study aims to improve identification of SM2 (submucosal-invasive) disease.

How were CE and EUS used in the study?

The study retrospectively assessed conventional endoscopy macroscopic morphology, EUS diagnostic accuracy, and clinicopathological correlations. Multivariate analysis identified predictors of SM2 invasion and informed a predictive nomogram.

What improves diagnostic performance for low-confidence CE-SM2 lesions?

For CE-SM2 low-confidence lesions, adding EUS showed a higher diagnostic yield compared with CE alone (41.7% vs. 24.0%).

Sep 30, 2026

Uploaded by Blitz