Analysis of metastases rates during follow-up after endoscopic resection of early “high-risk” esophageal adenocarcinoma

Esther A. Nieuwenhuis, Sanne N. van Munster, Dutch Barrett Expert Centers, Sybren L. Meijer, L. Brosens, Marnix Jansen, Bas L.A.M. Weusten, Lorenza Alvarez Herrero, Alaa Alkhalaf, Ed Schenk, Erik J. Schoon, Wouter L. Curvers, Arjun D. Koch, Steffi E.M. van de Ven, Eva P.D. Verheij, Wouter B. Nagengast, Jessie Westerhof, Martin H.M.G. Houben, Thjon Tang, Jacques J.G.H.M. BergmanRoos E. Pouw*, S. Meijer, M. Doukas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)
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Abstract

Background and Aims: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. Methods: For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. Results: One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers. Conclusions: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.

Original languageEnglish
Pages (from-to)237-247.e3
JournalGastrointestinal Endoscopy
Volume96
Issue number2
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: B. L. A. M. Weusten: Research support from C2 Therapeutics/Pentax Medical and Aqua Medical . J. J. G. H. M. Bergman: Research support from C2 Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. E. J. Schoon: Research support from Fujifilm. All other authors disclosed no financial relationships.

Publisher Copyright:
© 2022 American Society for Gastrointestinal Endoscopy

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