Endoscopic submucosal dissection (ESD) can be a viable option for patients with esophageal squamous high-grade dysplasia and early squamous cell carcinoma, challenging the conventional referral for surgical intervention.

• Curative resection rates were significantly higher for absolute criteria lesions at 71.8%, compared to just 19.4% for outside criteria lesions.
• Of the outside criteria group, nearly 20% achieved cure non-surgically.

Survival rates were excellent for curative cases, with 5-year overall survival at 95.5%.

• ESD can help with organ preservation and local disease control, making it a key consideration in treating these patients.