Management of high risk T1 esophageal adenocarcinoma following endoscopic resection.

High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact. Parallel to this development, new publications demonstrated that the risk of lymph node metastases for HR-T1 EAC may be even <24%. Therefore, indications for endoscopic treatment of HR-T1 EAC are being reconsidered and current research aims at finding the optimal management strategy for this indication, where watchful waiting may proof to be an acceptable strategy in selected patients. In this review, we will discuss the latest developments in this field.
Competing Interests: Declaration of competing interest P. Leclercq received speaker's fee, consultancy from Boston Scientific, Medtronic, Erbe, Fujifilm. R. Bisschops received speaker's fees, consultancy and research support from Pentax, Fujifilm and Medtronic, Boston Scientific. J.J.G.H.M. Bergman has received financial support for Institutional Review Board–approved research from C2Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. R.E. Pouw is consultant for Medtronic BV and MicroTech Europe, and received speaker fee from Pentax BV.
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