Factors influencing lateral margin diagnosis challenges in Barrett’s esophageal cancer: A bicenter retrospective study

Abstract

Abstract Background The endoscopic lateral diagnosis of Barrett's esophageal adenocarcinoma (BEA) has been reported as challenging. Therefore, we aimed to clarify the clinicopathological characteristics and cause of BEA with unclear demarcation. Methods We reviewed BEA cases resected endoscopically or operatively between January 2010 and August 2022 at two institutions. The lesions were classified into two groups: the clear demarcation group (CD group) and the unclear demarcation group (UD group). We then compared clinicopathological findings between the two groups. Furthermore, to elucidate the differences in pathological structures between the cancerous mucosa and the surrounding mucosa, we measured the length and width of foveolar, as well as the width of the marginal crypt epithelium (MCE). Results We analyzed 68 BEA cases, comprising 47 in the CD group and 21 in the UD group. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor (OR; 10.38, 95% CI;2.14–50.19, p = 0.004). Regarding pathological analysis, significant differences were observed in the length and width of foveolar between the cancerous and surrounding mucosa in the CD group (p = 0.03 and 0.00). However, in the UD group, these measurements did not show significant differences (p = 0.53 and 0.72). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p = < 0.05, and < 0.05). Conclusions The significant risk factor for UD group was LSBE. The width of MCE, showing significant differences between the cancerous and surrounding mucosa, may serve as an important asset in endoscopic diagnosis for BEA.