High rate of short segment Barrett’s Oesophagus in gastro-oesophageal junction zone adenocarcinoma and high grade dysplastic lesions – a retrospective cohort study

Aims The incidence of oesophageal adenocarcinoma has been increasing in recent years with Barrett’s oesophagus being the main identified precursor. Gastro-oesophageal junction (GOJ) adenocarcinomas are frequently seen, often with short segment, or at times in the absence of Barrett’s oesophagus. The GOJ zone, defined as 1cm proximal and distal to the GOJ, has been termed to highlight the unique pathophysiology in this area. We reviewed the histological outcome of endoscopically resected GOJ zone adenocarcinoma and high grade dysplastic (HGD) lesions in order to identify underlying neoplastic changes that may improve our understanding of the pathophysiology leading to cancer in this anatomical area.

Methods Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) procedures performed at Royal Perth Hospital from May 2013 to December 2023 were reviewed through our endoscopy reporting programme ProcRep. GOJ zone lesions were filtered manually through endoscopy report. Details including patients’ characteristics, histology reports and follow-up procedures were obtained via electronic records. Patients with histology showing high grade dysplasia or adenocarcinoma were included in the study. Histology results were revisited by a specialist pathologist to clarify whether features of Barrett's oesophagus were seen.

Results A total of 27 patients received endoscopic resection for GOJ zone lesions with HGD or adenocarcinomas, 13 underwent EMR and 14 underwent ESD. Mean lesion size was 15.1 mm. 13 of 27 patients had endoscopic evidence of Barrett’s oesophagus, 12 of whom had short segment Barrett’s oesophagus. Of the remaining 14 patients, 13 had resection specimen with histology supporting Barrett’s oesophagus, which included columnar lined mucosa with intestinal metaplasia and goblet cells. Overall, there were 15 (55.6%) T1a lesions and 6 (22.2%) HGD lesions, none of which developed recurrence. The remaining 6 patients had T1b lesions, 5 proceeded with oesophagectomy or chemoradiotherapy and 1 patient declined additional treatment, with absence of local recurrence on follow-up endoscopies [1] [2].

Conclusions Our study showed the majority of GOJ zone neoplastic lesions had underlying features of Barrett's oesophagus (96.3%). 44.4% had short segment Barrett's whilst 51.9% had no endoscopic evidence of Barrett's oesophagus but histological features were confirmed on resection specimen. Although evidence suggest the rate of progression in short and ultrashort segment Barrett's oesophagus to advanced dysplasia is low, our result shows majority of GOJ zone neoplastic lesions has underlying short or ultrashort segment Barrett's oesophagus. Further studies to identify other risk factors contributory to GOJ zone neoplasia is required to guide future decision on surveillance of ultrashort segment Barrett's oesophagus. Prior to such results, we propose vigilant inspection of the GOJ zone to identify potential neoplastic lesions.

Publication History

Article published online:
27 March 2025

• References

• 1 Weusten BLAM, Bisschops R, Dinis-Ribeiro M. et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2023; 55 (12): 1124-1146
• 2 Sugano K, Spechler SJ, El-Omar EM. et al. Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction. Gut 2022; 71: 1488-1514