To establish a prediction model to triage difficult esophageal endoscopic submucosal dissection (ESD) in order to reduce complications. This retrospective study enrolled 742 patients who underwent ESD for early esophageal cancer and precancerous lesions. Difficult ESDs were defined as those meeting any of the following criteria: (1) long procedure time (≥ 90 min), (2) occurrence of intraoperative adverse events (muscularis propria injury, perforation, and massive hemorrhage), or (3) piecemeal resection. Logistic regression analysis was performed to identify the predictors of technical difficulty. Then we developed a score prediction model according to the Framingham system for the first time and presented a convenient table containing the risk probability for each patient. In addition, the score model was validated in the validation cohort. The risk factors for difficult ESDs were as follows: lesion total length 4–6 cm (1 point), 7–9 cm (2 points) or ≥10 cm (3 points); lesion ≥ 2/3 circumference (2 points); preoperative invasion depth extending to submucosa (2 points). Areas under ROC curves for the score model in the derivation and validation sets were 0.768 (95% CI, 0.726–0.811) and 0.719 (95% CI, 0.646–0.793), respectively. In addition, the percentage of difficult ESDs in easy (score = 0), intermediate (score = 1–2), difficult (score = 3–4), and very difficult (score ≥5) categories were 14.8%, 36.1%, 62.6%, and 87.5% in the derivation cohort and 14.8%, 33.7%, 56.3%, and 68.8% in the internal validation cohort. We successfully established a prediction model to assess the difficulty of esophageal ESD and it can provide a scientific basis for clinical management to reduce complications.

Oesophageal stricture, especially circumferential lesions, is a common complication of endoscopic submucosal dissection (ESD). However, the exact mechanisms underlying its development remain unclear. Consequently, understanding tissue microenvironment changes is crucial for identifying therapeutic targets. To address this, single‐cell RNA sequencing (scRNA‐seq) was performed on oesophageal stricture samples and normal controls. Alterations in cellular composition were observed, particularly in epithelial, endothelial, fibroblast and immune cells. A notable increase was observed in the number of differentiating suprabasal cell_2 (DFSC_2), which displayed pro‐keratinizing traits. Detailed investigations revealed augmentation in a subset of these cells, characterised by elevated FTH1 and ECM1 expression, indicating their role in epithelial remodelling. Furthermore, fibroblast heterogeneity was demonstrated, with significant activation of myofibroblasts within stricture tissues. MDK–NCL, CXCL5/6‐CXCR2, and TGFA–EGFR ligand–receptor pairs were enhanced in stricture tissues, mediating epithelial–stromal interactions. This study dissected the transcriptional landscape of postoperative oesophageal stricture tissues, providing valuable insights into stricture mechanisms and potential preventive strategies.

Esophageal adenocarcinoma (EAC) is a highly aggressive malignancy with poor prognosis, often evolving from Barrett’s esophagus (BE). Understanding th