Back to 2025 Abstracts
TRENDS IN ESOPHAGECTOMY AND ENDOSCOPIC RESECTION INTERVENTION FOR BARRETT’S ESOPHAGUS AND EARLY-STAGE ESOPHAGEAL CANCER: A NATIONWIDE ANALYSIS (2014-2024)
Mahmoud Y. Madi
1, Yassine Kilani
*1, Thomas R. McCarty
3, Ahmad Najdat Bazarbashi
2, Raj Shah
41Gastroenterology & Hepatology, Saint Louis University, Saint Louis, MO; 2Washington University in St Louis, St Louis, MO; 3Houston Methodist, Houston, TX; 4The Ohio State University Wexner Medical Center, Columbus, OH
BackgroundSurgery for patients with Barrett’s esophagus (BE) and early-stage (T1) adenocarcinoma of the esophagus is usually considered when endoscopic treatment is not feasible or failed. Currently, there remains a lack of data on the trends of esophagectomy for BE or early stage adenocarcinoma of the esophagus. With advancements and increased adoption of endoscopic submucosal dissection (ESD) and mucosal resection (EMR), we anticipated fewer esophagectomies being performed. This study aimed to evaluate the trend of esophagectomy and endoscopic resection in this patient population from 2014 to 2024.
Methods We conducted a retrospective cohort study in the United States using the TriNetX research network to identify patients with BE or T1 esophageal adenocarcinoma who underwent esophagectomy and those who underwent EMR and ESD, excluding patients with esophageal cancer of higher stages or those with other surgical indications (stricture, achalasia, esophageal perforation). We assessed the yearly incidence of esophagectomy, EMR, ESD from 2014 to 2024. We retrieved data on baseline characteristics, including demographics (e.g., age, sex, race), body mass index (BMI), smoking history, alcohol use, gastroesophageal reflux disease (GERD), and family history of gastrointestinal malignancy.
ResultsA total of 368,573 adult patients with BE or T1 esophageal adenocarcinoma from 2014 to 2024 were included, among which 0.15% (n=552) underwent partial esophagectomy, while 1.7% (n=6471) underwent EMR or ESD. Patients who underwent esophagectomy for BE or T1 esophageal adenocarcinoma were younger (64 ± 9 years vs. 67 ± 11 years, p<0.0001), and had higher rates of smoking (19% vs. 13%, p<0.0001) and GERD (66% vs. 55%, p<0.0001) and a lower BMI (28 ± 6 vs. 30 ± 6, p<0.0001) compared to patients undergoing EMR or ESD (
Table 1). There was a minimal to no decline in the rates of esophagectomy for patients with BE or T1 esophageal adenocarcinoma (Incidence proportion: 2014 - 0.02%, 2024 – 0.01%;
Figure 1-A). In contrast, there was an increase in EMR and ESD rates in patients with BE or T1 esophageal adenocarcinoma during the same study period (Incidence proportion: 2014 - 0.14%, 2024 – 0.27%;
Figure 1-B)
ConclusionThis study provides real-world evidence of rates of esophagectomy for patients with BE and early stage esophageal adenocarcinoma. Despite increasing rates of endoscopic resection via EMR and ESD, there was no significant change in rates of esophagectomy over the past 10 years. Future studies to assess for uptake of endoscopic resection and specific factors that may contribute to a lack of change in rates of esophagectomy are needed.
Figure 1. Incidence of esophagectomy (
A) and endoscopic resection therapy (e.g., endoscopic mucosal resection, endoscopic submucosal dissection) (
B) in patients with Barrett esophagus and T1 esophageal adenocarcinoma from 2014 to 2024
Table 1. Baseline characteristics when comparing patients with Barrett’s esophagus and T1 esophageal adenocarcinoma undergoing esophagectomy and endoscopic resection interventions (e.g., endoscopic mucosal resection, endoscopic submucosal dissection) from 2014 to 2024
Back to 2025 Abstracts
