Low risk of esophageal adenocarcinoma among patients with ultrashort-segment Barrett's esophagus in Japan

Objective: To elucidate the carcinogenicity of Barrett's esophagus (BE) by length in Japan. Methods: 9843 consecutive participants who had undergone endoscopies at five facilities in Akita prefecture from January to December 2014 were enrolled. We investigated the incidence of esophageal adenocarcinoma (EAC) from BE during the period from January 2014 to December 2020. BE was classified into three groups: USSBE (Barrett's length <1 cm), SSBE (≥1 cm, <3 cm), and LSBE (≥3 cm). The incidence of gastric cancer during the same period was also examined.
Results: The mean age of the follow-up cases was 54 years (SD: ±9.9), 59.4% were male, the median number of endoscopies during the period was 4 (IQR: 3-5), and the median observation period was 59 months (IQR: 47-69). BE was present in 4190 patients: 3531 (36%) USSBE, 646 (6.6%) SSBE, and 13 (0.1%) LSBE. Two EAC were observed during the observation period, one from USSBE and the other from SSBE. The annual incidence rate from USSBE was 0.0068%. Whereas, the annual incidence rate of gastric cancer from non-atrophic gastritis was 0.0059% during the same period. Carcinogenesis from USSBE was as low as that from non-atrophic gastritis.
Conclusion: Carcinogenesis from USSBE, which accounts for the majority of Barrett's esophagus in Japan, is extremely rare.