Low risk of esophageal adenocarcinoma among patients with ultrashort‐segment Barrett's esophagus in Japan

Abstract

Objects Ultrashort‐segment Barrett’s esophagus (USSBE; length of <1 cm) is very frequently diagnosed in Japan, but the cancer risk of USSBE is unknown. In this study, by retrieving endoscopic images, we retrospectively investigated the incidence of esophageal adenocarcinoma (EAC) by the grade of Barrett’s esophagus (BE) and compared the findings with those of gastric cancer by the degree of endoscopic gastric atrophy in the same population. Methods Among consecutive participants who had undergone endoscopy for an annual health checkup in 2014, the 9121 who had received at least one follow‐up endoscopy by December 2020 were enrolled in this study. Using the retrieved endoscopic images, we retrospectively evaluated BE and gastric atrophy. Information on the subsequent occurrence of EAC and gastric cancer as of December 2020 was also collected. The incidence of cancer by the extent of BE and gastric atrophy was calculated and expressed as the percentage per year. Results On reviewing the endoscopic image in 2014, 4190 (45.9%) were found to have been diagnosed with BE, of whom 3318 (36.4%) were judged to have USSBE. During an observation period of 54.1 (17.9) months, 89 gastric cancers and only two EACs were identified. The incidence of EAC in USSBE was 0.0068%/year, which was nearly as low as the incidence of gastric cancer in atrophy‐free patients (0.0068% vs. 0.0059%/year). Conclusions Although the prevalence of USSBE is quite high (36.4%), the incidence of EAC in USSBE is very low (0.0068%/year). Accordingly, USSBE can be excluded from targets for endoscopic surveillance in Japan.

Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction

“…It should be noted that this new concept of BO does not imply that all the BO in this category should undergo surveillance. On the contrary, we do not recommend endoscopic surveillance of ultrashort segment BO (USSBO) with less than 1 cm of columnar metaplasia since an overall risk of developing OAC is very low despite that it has an increased risk per unit area comparable to short segment BO (SSBO) with 1–3 cm of columnar metaplasia (SSBO) 37…”

Current status of surveillance for Barrett's esophagus in Japan and the West

“…However, a recent retrospective cohort study in Japan reported that although the prevalence of USSBE is high (36.4%), the incidence of adenocarcinoma in USSBE is very low (0.0068% per year). 49 In addition, the aforementioned annual incidence of 0.47% of adenocarcinoma from SSBE longer than 2 cm, in Japan, 41 may be an important indicator for future stratification of Barrett's esophagus.…”

Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries

“…At the initial diagnosis, the Seattle biopsy protocol, which entails four‐quadrant biopsies every 2 cm in addition to targeted biopsies of macroscopically visible lesions, is recommended if the columnar lining is greater than 1 cm above the EGJ in most Western guidelines. 49 , 65 However, the protocol is time‐consuming, practicing endoscopists have poor adherence to it, and there is an increased risk associated with the large number of biopsy samples required. 66 Since the majority of BE is SSBE, targeted biopsies are the standard protocol for endoscopic observation in Japan.…”

“…Because of cases of over-and under-diagnosis, we demonstrated that the variance was unacceptably large (17.2%-96.8%),and the diagnostic accuracy was inadequate, especially in cases with a BE length of less than 1 cm, suggesting that the minimum length of CLE should be defined in future criteria in Japan. 48 Although most studies show that the incidence of EAC in BE of less than 1 cm in length is very low, 49 Barrie et al recently reported that almost 20% of all dysplasia in BE and EAC occurs within a centimeter of the EGJ, suggesting that all lengths of CLE above the EGJ should be recognized as BE and subjected to a thorough biopsy protocol. 50 Traditionally, BE is divided into long-segment BE (LSBE, ≥3 cm) and SSBE (<3 cm) based on the length of columnar mucosa in the distal esophagus as assessed by endoscopy.…”