Postoperative Clinical Features of High‐Grade Squamous Intraepithelial Neoplasia Dominated by Cytological Atypia After Endoscopic Submucosal Dissection

Objectives Despite the relatively comprehensive understanding of esophageal high‐grade intraepithelial neoplasia (HGIN), clinical characteristics of HGIN dominated by cytological atypia after endoscopic submucosal dissection (ESD) remain unclear. We aimed to investigate the postoperative features and adverse events of patients with this pathological feature after ESD. Methods We retrospectively analyzed the data of 160 patients who underwent ESD for HGIN from 2018 to 2019. The patient cohort was divided into two groups based on the histopathology of the resected lesions: dominated by architectural atypia (HGINa) and cytological atypia (HGINc). Information on postoperative adverse events (fever, perforation, hemorrhage, and esophageal stricture) and second‐stage endoscopic treatments was collected. Follow‐up was conducted until December 2024 to analyze postoperative new‐onset neoplasia between the two groups. Binary logistic regression analyses were used to assess risk factors for postoperative adverse events. Results Among all included patients, 43 (26.88%) and 117 (73.12%) were classified as having HGINc and HGINa, respectively. The rates of postoperative fever and new‐onset neoplasia were significantly higher in the HGINc group than in the HGINa group (both p < 0.05), and HGINc emerged as an independent risk factor for these outcomes. Muscularis propria injury and mucosal defect exceeding 75% of the circumference were associated with postoperative esophageal stricture. Conclusion Post‐ESD management should focus on fever and new‐onset neoplasia in patients with HGINc.