Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Surg Endosc. 2024 Jul;38(7):3636-3644. doi: 10.1007/s00464-024-10888-7. Epub 2024 May 20.
The incidence of Barrett's esophageal adenocarcinoma (BEA) is increasing, and endoscopic submucosal dissection (ESD) has been frequently performed for its treatment. However, the differences between the characteristics and ESD outcomes between short- and long-segment BEA (SSBEA and LSBEA, respectively) are unclear. We compared the clinicopathological characteristics and short- and long-term outcomes of ESD between both groups.
We retrospectively reviewed 155 superficial BEAs (106 SSBEAs and 49 LSBEAs) treated with ESD in 139 patients and examined their clinicopathological features and ESD outcomes. SSBEA and LSBEA were classified based on whether the maximum length of the background mucosa of BEA was < 3 cm or ≥ 3 cm, respectively.
Compared with SSBEA, LSBEA showed significantly higher proportions of cases with the macroscopically flat type (36.7% vs. 5.7%, p < 0.001), left wall location (38.8% vs. 11.3%, p < 0.001), over half of the tumor circumference (20.4% vs. 1.9%, p < 0.001), and synchronous lesions (17.6% vs. 0%, p < 0.001). Compared with SSBEA, regarding ESD outcomes, LSBEA showed significantly longer resection duration (91.0 min vs. 60.5 min, p < 0.001); a lower proportion of submucosal invasion (14.3% vs. 29.2%, p = 0.047), horizontal margin negativity (79.6% vs. 94.3%, p = 0.0089), and R0 resection (69.4% vs. 86.8%, p = 0.024); and a higher proportion of post-procedural stenosis cases (10.9% vs. 1.9%, p = 0.027). The 5-year cumulative incidence of metachronous cancer in patients without additional treatment was significantly higher for LSBEA than for SSBEA (25.0% vs. 0%, p < 0.001).
The clinicopathological features of LSBEA and SSBEA and their treatment outcomes differed in many aspects. As LSBEAs are difficult to diagnose and treat and show a high risk of metachronous cancer development, careful ESD and follow-up or eradication of the remaining BE may be required.
巴雷特食管腺癌（BEA）的发病率正在上升，内镜黏膜下剥离术（ESD）已被广泛用于其治疗。然而，短段 BEA（SSBEA）和长段 BEA（LSBEA）的特征和 ESD 结果之间的差异尚不清楚。我们比较了两组患者的临床病理特征和 ESD 短期和长期结果。
我们回顾性分析了 139 例患者中 155 例接受 ESD 治疗的浅表性 BEA（106 例 SSBEA 和 49 例 LSBEA），并检查了其临床病理特征和 ESD 结果。SSBEA 和 LSBEA 是根据 BEA 背景黏膜的最大长度是否<3cm 或≥3cm 进行分类的。
与 SSBEA 相比，LSBEA 更常见的表现为大体平坦型（36.7% vs. 5.7%，p<0.001）、左壁位置（38.8% vs. 11.3%，p<0.001）、肿瘤周长的一半以上（20.4% vs. 1.9%，p<0.001）和同时性病变（17.6% vs. 0%，p<0.001）。与 SSBEA 相比，LSBEA 的 ESD 切除时间明显更长（91.0 分钟 vs. 60.5 分钟，p<0.001）；黏膜下浸润率较低（14.3% vs. 29.2%，p=0.047）、水平切缘阴性率（79.6% vs. 94.3%，p=0.0089）和 R0 切除率（69.4% vs. 86.8%，p=0.024）；术后狭窄病例比例较高（10.9% vs. 1.9%，p=0.027）。未经额外治疗的患者中 LSBEA 的 5 年累积癌症发生率明显高于 SSBEA（25.0% vs. 0%，p<0.001）。
LSBEA 和 SSBEA 的临床病理特征及其治疗结果在许多方面存在差异。由于 LSBEA 难以诊断和治疗，并且有发生异时性癌症的高风险，因此可能需要仔细进行 ESD 治疗，并进行随访或根除剩余的 BE。
