Clinicopathological features of superficial Barrett’s esophageal adenocarcinoma.

Introduction: The diagnosis and curative strategy of superficial Barrett’s esophageal adenocarcinoma (BEA) are still challenging.
Method: From 2008 to 2022, 63 consecutive patients (57:ESD, 6: surgery) with 67 lesions with histologically diagnosed superficial BEA were enrolled. We evaluated retrospectively clinicopathological features and outcomes of the therapeutic strategy.
Result: The median age was 63 [IQR 53-70.5] years, the median BMI was 23.8 [IQR 　20.9-26.2]. 45(73%) patients had Short Barrett’s Esophagus including 32(51%) patients of Ultra-Short Barrett’s Esophagus. The median tumor size was 16 [IQR 8.5-21] mm. The macroscopic types are 0-I:6, 0-IIa:21, 0-IIb:4, 0-IIc:28, complex type:8 and histological types are well-moderately differentiated type: 66, mixed type (poorly differentiated component): 4, poorly-differentiated type:1. 54 and 13 lesions were T1a and T1b tumors respectively. The diagnostic accuracy of tumor depth was achieved in 45 lesions (71%), 3 lesions (5%) were under-diagnosed and 15 lesions(24% ) were over-diagnosed. Additionally, 2 over-diagnosed patients underwent surgery. Multivariate analysis revealed that depressed lesion and component of undifferentiated type were independent risk factors of T1b tumor. R0 resection was achieved in 55/ 57 (96%) ESD patients. No perforation, delayed bleeding and stenosis were occurred during the observation period.
Conclusion: Predicting the invasion depth of superficial BEA is difficult. ESD should be primary therapeutic option due to high curative rate and few adverse effects.