OA04.5. Diagnostic Accuracy of Japanese Esophageal Society Magnifying Endoscopic Classification for Superficial Esophageal Squamous Cell Carcinoma in the Orifice–Cervical Esophagus

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ID: 326058
2026
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Ranked #363 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Other Background Endoscopic evaluation of superficial esophageal squamous cell carcinoma (SESCC) in the esophageal orifice and cervical esophagus is technically challenging because of anatomical constraints and the swallowing reflex. Moreover, the accuracy of invasion depth assessment using the Japanese Esophageal Society (JES) magnifying endoscopic classification in this region remain unclear. Methods We retrospectively analyzed 523 SESCC lesions in 440 patients who underwent endoscopic submucosal dissection between January 2009 and December 2024 and had evaluable magnifying image-enhanced endoscopy findings. Lesions diagnosed as JES Type B1 or B2 vessels were included. According to tumor location, lesions were categorized into the esophageal orifice–cervical (OC) group and the thoracic–abdominal (TA) group. The primary objective of this study was to determine whether differences in diagnostic accuracy exist between the OC and TA groups. First, overall diagnostic accuracy was evaluated as concordance between endoscopic depth prediction (B1 defined as pEP/LPM and B2 as pMM/SM1) and histopathological findings. Subsequently, diagnostic accuracy was compared between the OC and TA groups. Lesions diagnosed as Type B3 vessels were excluded from the analysis because no B3 lesions were identified in the OC group. Results Overall diagnostic accuracy was 94.6% (388/410) for B1 predicting pEP/LPM and 61.1% (69/113) for B2 predicting pMM/SM1, consistent with previous reports. The overall diagnostic accuracy was 81.5% (22/27) in the OC group and 87.7% (435/496) in the TA group, with no significant difference between the groups. However, among lesions diagnosed as B1 vessels, diagnostic accuracy was significantly lower in the OC group than in the TA group (82.6% (19/23) vs. 95.3% (369/387), p = 0.028). All four misclassified lesions in the OC group were pathologically diagnosed as pMM, and one lesion exhibited lymphovascular invasion. In contrast, among lesions diagnosed as B2 vessels, diagnostic accuracy did not differ significantly between the OC and TA groups (75.0% (3/4) vs. 60.6% (66/109)). Conclusion In the OC group, magnifying image-enhanced endoscopy was performed under general anesthesia, thereby eliminating the influence of the swallowing reflex; nevertheless, the diagnostic accuracy for B1 lesions was significantly lower in the esophageal inlet–cervical region. White deposits were observed in approximately 70% of lesions in the OC group and may have impaired microvascular visualization. These findings suggest that particular caution is warranted to avoid underestimation of invasion depth in the OC region.
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Authors Hidehito Maeda, Fumisato Sasaki, Takayuki Ohi, Naohiro Koyoshi
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.033
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.033/70760985/doag077.033.pdf
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