Features of esophageal adenocarcinoma in magnifying narrow-band imaging.

BACKGROUND Several endoscopic classifications for esophageal adenocarcinoma have been proposed; however, gastric adenocarcinoma is much more common than esophageal or esophagogastric junctional (EGJ) adenocarcinoma in East Asian countries. We therefore investigated whether an endoscopic diagnostic algorithm for gastric adenocarcinoma could be used for esophageal or EGJ adenocarcinoma. METHODS One hundred and eighteen consecutive patients who underwent endoscopic resection or surgery for intramucosal esophageal or EGJ adenocarcinoma, at Osaka International Cancer Institute between January 2006 and December 2017, were included in this retrospective study. Their lesions were classified as Siewert type I or II, and the presence of endoscopic magnifying narrow-band imaging findings for diagnosing gastric adenocarcinoma was evaluated. RESULTS We evaluated 125 adenocarcinomas in 118 patients (29 type I and 96 type II). Demarcation lines (DLs) were seen in 7 (24%) type I and 53 (55%) type II lesions. Irregular mucosal patterns were present in 2 (7%) type I and 22 (23%) type II lesions. Irregular vascular patterns were present in 26 (90%) type I and 50 (52%) type II lesions. According to the magnifying endoscopy diagnostic algorithm for gastric adenocarcinoma, only 7 (24%) type I and 52 (54%) type II lesions were correctly diagnosed as cancers (P = 0.005). CONCLUSION The magnifying endoscopy diagnostic algorithm for gastric cancer may not be useful for esophageal or EGJ adenocarcinomas because of the low visibility of DLs, especially in Siewert type I adenocarcinoma.