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Background With the advancement of endoscopic techniques, superficial pharyngeal squamous cell neoplasms (SPSCN) can be detected early. This study aimed to analyze the clinical and endoscopic pathological characteristics of SPSCN, evaluate the safety and efficacy of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).Methods A retrospective analysis was conducted on the clinical, endoscopic, and pathological data of 30 SPSCN patients who underwent endoscopic treatment at the Digestive Endoscopy Center of Shandong Second Provincial Hospital from March 2021 to August 2025.Results All 30 patients were male, with a mean age of 62.07 years. 23.3% had multiple SPSCN lesions, and 60% had concurrent or prior esophageal/pharyngeal tumors. A total of 40 lesions were included, with 85% located in the hypopharynx, most commonly in the right pyriform sinus. Endoscopically, lesions often appeared red, with 0-IIa and 0-IIc types being predominant; 85% showed a brownish color under non-magnifying narrow-band imaging (NBI). Referring to the Japanese Esophageal Society (JES) magnification classification, the preoperative diagnostic accuracy was 75%. The preoperative biopsy rate was 60%, with 25% showing pathological upgrading postoperatively. The mean tumor diameter was 15.95 mm. EMR was performed on 8 lesions; ESD ( IDDF2026-ABS-0047 Figure 1. ESD treatment for a case of early cancer in the right piriform sinus) was performed on 32 lesions, with a mean dissection speed of 21.01 mm2/min (range 5.23–69.26 mm2/min). The en bloc resection rate and R0 resection rate were both 100%. All patients were successfully extubated on the day of surgery, with no significant intraoperative or postoperative complications such as bleeding, perforation, or laryngeal edema. The mean follow-up period was 22.03 months. During this time, 2 patients developed synchronous SPSCN, and 1 developed metachronous SPSCN. No recurrence, new occurrence, or metastasis was observed in the remaining cases.Conclusions SPSCN predominantly affects elderly males and is most commonly found in the right pyriform sinus of the hypopharynx. Endoscopically, they often appear red, primarily presenting as 0-IIa and 0-IIc types, and frequently exhibit a tea-colored sign under NBI. The Japanese JES magnification classification shows good diagnostic value for SPSCN. Endoscopic resection (including EMR and ESD) is a safe and effective minimally invasive treatment for SPSCN.Abstract IDDF2026-ABS-0047 Figure 1