DIFFERENCES OF SUPERFICIAL BARRETT'S ESOPHAGEAL ADENOCARCINOMA (S-BEA) BETWEEN SSBE AND LSBE

Aims:

With regard to therapy of superficial Barrett's esophageal adenocarcinoma (S-BEA) and dysplasia, there is a significant difference between Japan and other Western countries. In Japan, S-BEAs are treated mainly by ESD, however in western countries, those are treated by RFA. The cause of this difference is origin of S-BEA, SSBE or LSBE. Most Japanese S-BEA cases originated from SSBE. S-BEA cases originate from LSBE in western countries. We conducted in this study to find the clinical differences between S-BEA cases which originated from LSBE and SSBE.

Methods:

131 S-BEA were examined (BEA originated from SSBE: 101 cases (101 lesions), LSBE: 23 cases (30 lesions)). All cases were treated with ESD or surgery. We examined the differences in endoscopic findings and histology between S-BEA cases which originated from SSBE and LSBE retrospectively.

Results:

Differences of both S-BEA, SSBE vs. LSBE = age 63:63 (N.S), Gender (M:F) 88:13 vs. 22:1 (N.S), Endoscopic Resection: Surgery 83:18 vs. 13:17 (< 0.05) Additional operation after ER 13:2 (N.S), lesion size 15 mm:27 mm (< 0.05) M:SM = 65:36, 20:10 (N.S) Histological type 74:27. 22:8 (N.S),

Macroscopic type: Simple type (elevated or depressed) and Complex type (elevated with flat lesion or depressed lesion, Depressed type with flat lesion) Simple type vs. Complex type SSBE 68:34, LSBE 16:15 (p < 0.05) flat spreading containing rate: SSBE 2/101 (2%) LSBE 6/30 (20%) p < 0.05 Submucosal invasion rate: Simple type 17/83 (19%) Complex type 26/48 (62%) p < 0.05.

Conclusions:

Macroscopic type is significant difference between S-BEA originated from SSBE and LSBE. S-BEA originating from LSBE had high rate of macroscopically complex type, flat spreading cancer and submucosal invasive lesions. On the other hand, S-BEA originating from SSBE had macroscopically simple type. According to our data, the etiology of S-BEA is different between LSBE and SSBE.