The literature said 41 to 46% of high-risk early oesophageal cancers already have nodal disease. Newer data from patients followed after endoscopic resection puts it nearer 16%, which means sending all of them to surgery operates on more than 80% for nothing.

Recorded after the UEG online course on oesophageal cancer, three specialists work through the questions the guidelines have not settled. Roos Pouw on when strict endoscopic follow-up can replace oesophagectomy, and exactly what that follow-up schedule looks like. Ana-Maria Bucalau on why six biopsies no longer covers the biomarker panel, and what ESOPEC and MATTERHORN change about neoadjuvant choice. Jessie Elliott on Siewert type II surgery, and on ENSURE, which found intensive surveillance detects recurrence earlier without improving survival while increasing cancer worry.

The SARONG surveillance trials are still recruiting and Jessie is open to hearing from interested centres. Full course at gutflix.eu.

Further reading:

1. ESGE tissue sampling guideline, Part 1 (biopsy numbers) 2. PREFER registry, endoscopic follow-up after high-risk T1 resection 3. ESOPEC, N Engl J Med 2025;392(4):323-335 4. MATTERHORN, N Engl J Med 2025;393(3):217-230 5. CARDIA protocol, BMC Cancer 2020;20(1):781 6. ENSURE, Ann Surg 2023;277(5):e1035-e1044 7. SARONG-II