CURRENT STATUS AND ISSUES OF ENDOSCOPIC TREATMENT FOR ESOPHAGEAL ADENOCARCINOMA

Abstract

Endoscopic mucosal resection (EMR) for nodular lesions indicating esophageal adenocarcinoma or high-grade dysplasia followed by ablative therapy, such as radiofrequency ablation, for residual Barrettʼs esophagus (combination therapy) is mainly conducted in Western countries, where the incidence of esophageal adenocarcinoma arising from long-segment Barrettʼs esophagus is high. On the other hand, in Japan, the first choice of treatment for mucosal esophageal adenocarcinoma is endoscopic submucosal dissection (ESD) after identifying the entire margin. In previous reports, the en bloc resection rate and curative resection rate of ESD for esophageal adenocarcinoma were approximately 100% and less than 65%, respectively. These results may be associated with the difficulty in diagnosing the horizontal extent and invasion depth; this is an issue that needs to be resolved. For risk assessment after endoscopic resection, lymphovascular involvement, a poorly differentiated component, and >30 mm in size are risk factors for metastasis. In Western guidelines, lesions without these factors are considered as suitable candidates for curative endoscopic resection. The results from a multicenter retrospective study in Japan supported these criteria. However, further investigation is necessary to establish the criteria for curative resection of esophageal adenocarcinoma.