title: Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection.
abstract: OBJECTIVE
  To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments.
  
  
  METHODS
  Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC.
  
  
  RESULTS
  Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified.
  
  
  CONCLUSIONS
  Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Darren D
authors.initials: DD
authors.lastname: Ballard
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Neel
authors.initials: N
authors.lastname: Choksi
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Jingmei
authors.initials: J
authors.lastname: Lin
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Choi
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Henry
authors.initials: H
authors.lastname: Appelman
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: Hala
authors.initials: H
authors.lastname: Fatima
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: William
authors.initials: W
authors.lastname: Kessler
authors.affiliation: Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
keywords: Chemotherapy; Endoscopic mucosal resection; Esophageal cancer; Esophagectomy; Submucosal; T1b