Characteristics and Prognosis of Esophageal Squamous Cell Carcinoma that Progressed to pT1a-MM or Deeper despite Surveillance Esophagogastroduodenoscopy

INTRODUCTION: In the surveillance of esophageal squamous cell carcinoma (ESCC), advanced lesions may still be detected despite regular screening with esophagogastroduodenoscopy (EGD). In this study, we investigated the endoscopic characteristics and prognosis of ESCC cases that progressed to pT1a-MM or deeper despite undergoing surveillance EGD. METHODS: We retrospectively analyzed 225 consecutive superficial ESCC lesions invading beyond the muscularis mucosa that were resected by endoscopic submucosal dissection (ESD) from 215 patients at Hiroshima University Hospital between April 2010 and March 2023. Among them, 28 patients (29 lesions) were classified as the post-EGD ESCC (PEESCC) group, defined as cases where surveillance EGD performed 24 months before diagnosis did not detect neoplasia or carcinoma. The remaining 188 patients (196 lesions) were the screening group. Subsequently, endoscopic findings and prognosis were compared. RESULTS: From the multivariate analysis, the presence of Lugol-voiding lesions (69.0% vs. 39.3%), cervical esophageal location (17.2% vs. 3.1%), small tumor diameter (21.6 ± 12.3 mm vs. 34.0 ± 18.3 mm), and submucosal tumor (SMT)-like elevation (20.7% vs. 7.7%) were significantly identified as characteristic endoscopic findings of PEESCC. The PEESCC group exhibited lower 5-year disease-specific survival (93.1% vs. 98.5%, p = 0.039) and recurrence-free survival (69.0% vs. 83.7%, p = 0.025). CONCLUSION: PEESCC lesions are associated with distinct endoscopic features and a poorer prognosis than are non-PEESCC lesions.