P2748 - Outcomes After Endoscopic Resection for Esophageal Adenocarcinoma: Insights into Curative Potential and Prognostic Indicators

Amna Anzar, MD, MS, Amitabh Chak, MD, FACG, Joseph Willis, MD
University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: Endoscopic resections (ER) with curative intent are routinely performed on newly diagnosed esophageal adenocarcinomas (EAC). Few studies exist correlating pathological features in ERs and clinical outcomes. This retrospective study examines the significance of standard clinical and ER pathologic features from a single tertiary-care institution and their association with patient outcome.

Methods: A retrospective study of EAC patients who underwent EMR/ESD from 2004–2023 was performed. Pathologic features of ER specimens were assessed along with clinical outcomes. Outcomes assessed included local/regional recurrence, follow-up ER or esophagectomy, and disease-specific mortality. Follow-up was recorded in months and correlated with pathology findings.

Results: 57 ER patients were identified. 53 patients underwent EMR, 4 ESD. Median follow-up was 53 months [range 3 – 1002].
34 patients underwent one ER, 5 underwent follow-up ER after primary resection. 18 patients underwent follow-up esophagectomy - 14 patients had no evidence of recurrence with a median follow-up of 66 months (range 16 – 195), 1 patient developed evidence of distant metastases.

Pathologic features: 2 of 9 Grade 3 EACs; 4 of 5 with LVI, 14 of 30 with deep margin positive, 13 of 23 with mucosal margin positive had poor outcomes. Only 6 of 26 fragmented specimens were associated with poor outcomes. Table 1 compares the pathological features of initial ERs and patient follow-up.

Discussion: Our findings support the curative potential of endoscopic resection for the majority patients with superficial EAC. Though recurrence rates are low in these preselected patients, pathological assessments of tumor grade, lymphovascular invasion, and margin status – esp. deep margin, emerged as important predictors of recurrence. Consideration of EAC endoscopic resection pathological findings is central to ongoing surveillance of these high-risk patients.


Figure: Table 1 - Endoscopic Resection Pathological Features and Patient Outcomes

Disclosures:
Amna Anzar indicated no relevant financial relationships.
Amitabh Chak: Lucid Dx – Consultant, Grant/Research Support, Intellectual Property/Patents, Owner/Ownership Interest, Royalties, Stock Options, Stock-publicly held company(excluding mutual/index funds). MicroTech – Consultant. Pentax – Consultant. Steris – Consultant.
Joseph Willis: Lucid Diagnostics – Consultant, Intellectual Property/Patents, Royalties.

Amna Anzar, MD, MS, Amitabh Chak, MD, FACG, Joseph Willis, MD. P2748 - Outcomes After Endoscopic Resection for Esophageal Adenocarcinoma: Insights into Curative Potential and Prognostic Indicators, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.