Barrett's esophagus
ICD-10 K22.7 · ICD-11 DA23.0

Treatment of Barrett's Esophagus with Esophageal Adenocarcinoma and Superficial Submucosal Invasion (T1b, sm1)

When Barrett's esophagus progresses to esophageal adenocarcinoma with early submucosal invasion, the balance between endoscopic and surgical management becomes a central clinical question. For a defined low-risk subgroup, an endoscopic-first approach is supported by evidence.

Clinical scenario Esophageal adenocarcinoma with superficial submucosal invasion (T1b, sm1; invasion into the upper third of the submucosa to a depth <500 mm) in the presence of low-risk features: negative deep margin, well to moderate tumour differentiation, and no lymphovascular invasion.
Approach (overview only — full regimen available via the protocol) Endoscopic eradication therapy (EET) is considered a viable alternative to esophagectomy in patients meeting this low-risk profile. The complete structured regimen — including sequencing and all decision points — is available in the full protocol.
Treatment goals: Complete eradication of dysplasia (CED) and complete eradication of intestinal metaplasia (CEIM) of the esophagus.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000001680

Observational data suggest that EET may be a viable alternative to esophagectomy for patients with T1b EAC with superficial submucosal invasion (sm1—invasion into the upper third of the submucosa to a depth <500 mm) and low-risk features such as deep margin negative, well-moderate differentiation and no lymphovascular invasion.

Contemporary practice includes endoscopic resection (ER) of any visible lesion within the BE segment, followed by ablative techniques such as RFA and cryotherapy to achieve complete eradication of dysplasia (CED) and IM (CEIM).

View source ↗