Low prevalence of submucosal invasive carcinoma at esophagectomy for high-grade dysplasia or intramucosal adenocarcinoma in Barrett's esophagus: a 20-year experience

Gastrointest Endosc. 2009 Apr;69(4):777-83. doi: 10.1016/j.gie.2008.05.013. Epub 2009 Jan 10.


Background: The rate of occult adenocarcinoma at esophagectomy in patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) has been reported to be approximately 40%. Recently, it has been suggested that this risk may be overestimated.

Objective: Our purpose was to determine the rate of submucosal invasive adenocarcinoma in patients undergoing esophagectomy for BE after biopsy diagnosis of HGD or intramucosal carcinoma (IMC). A secondary aim was to identify clinical risk factors for submucosal invasive adenocarcinoma in these patients.

Design: A retrospective study.

Setting: Tertiary referral center.

Patients: All patients with preoperative BE with HGD or IMC treated with esophagectomy over a 20 year period.

Interventions: Esophagectomy.

Main outcome measurements: Submucosal invasive adenocarcinoma at esophagectomy.

Results: Sixty patients were included (41 with preoperative HGD, 19 with preoperative IMC). The overall rate of submucosal invasive carcinoma was 6.7% (95% CI, 1.8%-16.2%) (n = 4), with a 5% rate of submucosal invasion in patients with preoperative HGD and 11% for patients with preoperative IMC. All 4 patients with submucosal invasion at esophagectomy had either nodular or ulcerated mucosa on preoperative endoscopy. The 1-year and 5-year all-cause risks of death for the entire cohort were 1.9% and 10.9%, respectively.

Limitations: Retrospective study.

Conclusions: The rate of submucosal invasive adenocarcinoma at esophagectomy in BE patients with HGD or IMC on biopsy is much lower than 40%. After adequate sampling and staging, patients with BE with HGD and IMC, especially those without endoscopically visible lesions, can potentially be treated by nonsurgical (local) therapies.

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / epidemiology*
  • Adenocarcinoma / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / complications
  • Barrett Esophagus / pathology*
  • Barrett Esophagus / surgery*
  • Esophageal Neoplasms / complications
  • Esophageal Neoplasms / epidemiology*
  • Esophageal Neoplasms / pathology*
  • Esophagectomy*
  • Esophagoscopy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mucous Membrane / pathology
  • Neoplasm Invasiveness
  • Prevalence
  • Retrospective Studies
  • Time Factors