TY - JOUR
T1 - Advancing Approaches for Superficial Esophageal Adenocarcinoma
T2 - Shifting Toward More Patient-tailored Therapy
AU - Verheij, E. P. D.
AU - van Munster, S. N.
AU - Bergman, J. J. G. H. M.
AU - Pouw, R. E.
N1 - Funding Information: Conflicts of Interest These authors disclose the following: J.J.G.H.M. Bergman received financial support for IRB-approved research from Medtronic, C2 Therapeutics/Pentax Medical, and Aqua Medical; R.E. Pouw is a consultant for Medtronic and MicroTech and received a speaker fee from Pentax. The remaining authors disclose no conflicts. Funding None. Publisher Copyright: © 2023 The Author(s)
PY - 2023/1
Y1 - 2023/1
N2 - The incidence of superficial esophageal adenocarcinoma (EAC) is rising and warrants awareness. Invasive surgery with lymph node dissection was long standard treatment for EAC. However, endoscopic resection techniques, such as cap-based endoscopic resection or endoscopic submucosal dissection (ESD), have proven to be safe and effective alternatives for removal of superficial EAC. Therefore, endoscopic resection is now the cornerstone of management for superficial EAC, for both diagnostic and therapeutic purposes. Current guidelines advise use of the cap-based approach for small, flat lesions, whereas ESD is recommended for large and bulky lesions, lesions with suspected submucosal invasion, or lesions in scarred areas. The histopathological assessment after a resection, evaluating histological risk factors for lymph node metastases, plays a key role in the decision about whether additional surgery is indicated. Until recently, all submucosal and/or high-risk EAC had an indication for additional (prophylactic) surgery because of the assumed high risk for lymph node metastases. However, this risk appears lower than initially assumed, and endoscopic management for low-risk submucosal EAC is gaining acceptance. Ongoing prospective trials will help to determine whether a watchful waiting strategy could be an alternative to surgery in patients with submucosal and/or high-risk EAC. In the future, the distinction between patients who can safely be followed with a watchful waiting strategy and patients who might benefit from additional surgery could become more unambiguous, resulting in more optimal patient-tailored management for patients with superficial EAC.
AB - The incidence of superficial esophageal adenocarcinoma (EAC) is rising and warrants awareness. Invasive surgery with lymph node dissection was long standard treatment for EAC. However, endoscopic resection techniques, such as cap-based endoscopic resection or endoscopic submucosal dissection (ESD), have proven to be safe and effective alternatives for removal of superficial EAC. Therefore, endoscopic resection is now the cornerstone of management for superficial EAC, for both diagnostic and therapeutic purposes. Current guidelines advise use of the cap-based approach for small, flat lesions, whereas ESD is recommended for large and bulky lesions, lesions with suspected submucosal invasion, or lesions in scarred areas. The histopathological assessment after a resection, evaluating histological risk factors for lymph node metastases, plays a key role in the decision about whether additional surgery is indicated. Until recently, all submucosal and/or high-risk EAC had an indication for additional (prophylactic) surgery because of the assumed high risk for lymph node metastases. However, this risk appears lower than initially assumed, and endoscopic management for low-risk submucosal EAC is gaining acceptance. Ongoing prospective trials will help to determine whether a watchful waiting strategy could be an alternative to surgery in patients with submucosal and/or high-risk EAC. In the future, the distinction between patients who can safely be followed with a watchful waiting strategy and patients who might benefit from additional surgery could become more unambiguous, resulting in more optimal patient-tailored management for patients with superficial EAC.
KW - Barrett's esophagus
KW - Esophageal cancer
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=85148755738&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.tige.2023.01.001
DO - https://doi.org/10.1016/j.tige.2023.01.001
M3 - Review article
SN - 2666-5107
VL - 25
SP - 177
EP - 185
JO - Techniques and Innovations in Gastrointestinal Endoscopy
JF - Techniques and Innovations in Gastrointestinal Endoscopy
IS - 2
ER -