We read the article published in Gut by Morais et al 1 with great interest. The authors retrospectively analysed the risk of lymph node metastasis (LNM) after high-risk resection (HRR) of gastric endoscopic submucosal dissection (ESD) in European countries. They validated the eCura system, consisting of five pathological factors,2 externally and internationally to predict LNM after HRR with prominent discriminative ability (area under the curve (AUC): 0.900). Furthermore, they developed a modified eCura system, the W-eCura score, which used a submucosal invasion depth of ≥1 mm, instead of ≥0.5 mm, and demonstrated a higher discriminative ability with an AUC of 0.916. While we respect their efforts in providing the first findings on LNM risk after HRR from European countries, some points require further discussion.

First, the prominent discriminative ability of both the original …