{
  "abstract": "Introduction Optimal endoscopic treatment of early neoplastic lesions of the gastro-oesophageal junction (GOJ) is not fully characterised, given its anatomic location between two adjacent organs. The presence of Barrett’s oesophagus may have prognostic implications. This study aimed to identify predictors of curative resection in Siewert type II GOJ lesions and compare outcomes upon treatment with endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).Methods This retrospective two-centre cohort study included consecutive patients (2011-2025) who underwent endoscopic resection for early Siewert type II GOJ neoplasia at two tertiary referral centres. Lesions with endoscopically visible Barrett’s were classified as Barrett’s-related (BR). The primary endpoint was curative resection rate, defined as R0 resection (negative deep margin for EMR; negative deep and lateral margins for ESD), histological grade≤G2 and no lymphovascular invasion. Secondary endpoints included local recurrence of high-grade dysplasia/adenocarcinoma and surgery within 12 months from resection. A multivariable logistic regression model adjusted for age, sex and Barrett’s status. Comparisons of EMR and ESD, and of BR and non-BR lesions, were performed using χ 2 tests for the primary endpoint and Fisher’s exact test for secondary endpoints due to low expected frequency; p<0.05 was considered statistically significant.Results We included 158 patients (mean age 69±10.7 years, 76.6% male): 137 adenocarcinomas and 21 high-grade dysplasia. Baseline resection was performed with EMR (n=96) or ESD (n=62). Curative resection was achieved more frequently in BR lesions than non-BR (71.7% vs 53.8%; p=0.026). In the regression model the presence of Barrett’s epithelium was an independent predictor of curative resection (OR 2.54; 95% CI 1.16–5.63; p=0.020). Non-BR lesions demonstrated a more aggressive profile than BR lesions, with a greater prevalence of lymphovascular invasion (25.6% vs 8.2%; p=0.006), a higher rate of submucosal invasion (47.6% vs 22.5%; p=0.004) and a higher rate of poor differentiation (G3: 21.4% vs 13.3%; p=0.255). For BR lesions (n=106), curative resection rates were comparable between EMR and ESD (71.2% vs 73.1%; p=0.860) with similar rates of recurrence (23.1% vs 23.8%; p=1.000) and surgery (5.1% vs 4.2%; p=1.000). For non-BR lesions (n=52), there was a trend towards higher curative resection with ESD compared to EMR (61.1% vs 37.5%, p=0.114), with non-significantly different rates of recurrence (7.1% vs 25.0%; p=0.149) and surgery (15.6% vs 14.3%; p=1.000).Conclusions Barrett’s oesophagus adjacent to GOJ neoplastic lesions may be associated with a higher rate of curative endoscopic resection due to a less aggressive phenotype. Our data also suggest ESD should be preferred over EMR for GOJ-associated non-Barrett’s lesions.",
  "authors": [
    {
      "affiliations": [
        "Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom"
      ],
      "name": "Andrew Lee"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Aleksandra Sztogrin-Pluta"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Marta Czapnik"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Wojciech Korcz"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Nastazja Pilonis"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Jaroslaw Regula"
    },
    {
      "affiliations": [
        "Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom"
      ],
      "name": "Vijay Sujendran"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Michal Kamiński"
    },
    {
      "affiliations": [
        "Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom"
      ],
      "name": "Massimiliano di Pietro"
    },
    {
      "affiliations": [
        "Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland"
      ],
      "name": "Władysław Januszewicz"
    }
  ],
  "title": "P43 Predictors of endoscopic treatment outcomes in early gastroesophageal junction neoplasia: a multicentre retrospective study",
  "uid": "3bc63d7f-4ad8-5266-b3a0-47087f7c24a1"
}