Columnar-lined esophagus measuring less than 1 cm as a risk factor for esophageal squamous cell carcinoma in Japanese men

BACKGROUND AND AIMS: Several case series have noted an association between Barrett's esophagus (BE) and esophageal squamous cell carcinoma (ESCC). We conducted a nationwide retrospective cohort study to examine the association between baseline BE status, particularly ultra-short-segment BE (USSBE; BE <1 cm), and subsequent ESCC development, focusing on the presence or absence of extensive gastric atrophy (GA). METHODS: Consecutive male participants who underwent endoscopy at 17 health check-up institutes in Japan between 2013 and 2017 and had follow-up endoscopy by December 2022 were enrolled. Baseline endoscopic images were reviewed to assess GA and BE status. The primary outcome was ESCC development during follow-up. The association between BE status and ESCC was estimated using the Kaplan-Meier method and Cox regression. RESULTS: Among 20,402 male subjects, 7161 (35.1%) had USSBE. During 116,483.1 person-years of follow-up, 73 cases of ESCC developed. The incidence of ESCC was highest among individuals with USSBE (0.0946%/year). Multivariable analysis revealed that USSBE was independently associated with ESCC (adjusted hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.03-3.24). In exploratory subgroup analyses, USSBE was independently associated with ESCC (adjusted HR 2.40, 95% CI 1.13-5.13) among individuals with extensive GA, while no significant association was observed among those without (adjusted HR 1.34, 95% CI 0.64-2.81; p for interaction = 0.369). CONCLUSIONS: This is the first study to demonstrate a significant association between USSBE and ESCC. USSBE may help identify individuals at increased risk of ESCC. Exploratory subgroup findings according to GA status require further validation.

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Journal
Journal of Gastroenterology
Published
2026-10-29
DOI
https://doi.org/10.1007/s00535-026-02532-z
Primary Topic
Esophageal Cancer Research and Treatment
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article
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article

Columnar-lined esophagus measuring less than 1 cm as a risk factor for esophageal squamous cell carcinoma in Japanese men

Sho Fukuda, Kenta Watanabe, Yoshihiro Otsuka, Kyoichi Adachi et al.
3 links
Journal of Gastroenterology
Esophageal Cancer Research and Treatment
article

Columnar-lined esophagus measuring less than 1 cm as a risk factor for esophageal squamous cell carcinoma in Japanese men

Sho Fukuda, Kenta Watanabe, Yoshihiro Otsuka, Kyoichi Adachi, Katsunori Iijima, Rie Yoshimura, Yugo Iwaya, Akira Horiuchi, Takuma Okamura, Dai Kubota, Tomoyuki Koike, Yasuhiko Abe, Kiyotaka Asanuma, Noriaki Manabe, Nobutake Yamamichi, 原口和大, Yoshitaka Watanabe, Kengo Onochi, Eikichi Ihara, Tatsuki Yoshida, Takashi Kon, Mio Matsumoto, 悠 髙橋, So Takahashi, Hideyuki Sugawara, Norihisa Ishimura
article en

Abstract

BACKGROUND AND AIMS: Several case series have noted an association between Barrett's esophagus (BE) and esophageal squamous cell carcinoma (ESCC). We conducted a nationwide retrospective cohort study to examine the association between baseline BE status, particularly ultra-short-segment BE (USSBE; BE <1 cm), and subsequent ESCC development, focusing on the presence or absence of extensive gastric atrophy (GA). METHODS: Consecutive male participants who underwent endoscopy at 17 health check-up institutes in Japan between 2013 and 2017 and had follow-up endoscopy by December 2022 were enrolled. Baseline endoscopic images were reviewed to assess GA and BE status. The primary outcome was ESCC development during follow-up. The association between BE status and ESCC was estimated using the Kaplan-Meier method and Cox regression. RESULTS: Among 20,402 male subjects, 7161 (35.1%) had USSBE. During 116,483.1 person-years of follow-up, 73 cases of ESCC developed. The incidence of ESCC was highest among individuals with USSBE (0.0946%/year). Multivariable analysis revealed that USSBE was independently associated with ESCC (adjusted hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.03-3.24). In exploratory subgroup analyses, USSBE was independently associated with ESCC (adjusted HR 2.40, 95% CI 1.13-5.13) among individuals with extensive GA, while no significant association was observed among those without (adjusted HR 1.34, 95% CI 0.64-2.81; p for interaction = 0.369). CONCLUSIONS: This is the first study to demonstrate a significant association between USSBE and ESCC. USSBE may help identify individuals at increased risk of ESCC. Exploratory subgroup findings according to GA status require further validation.

Journal of Gastroenterology
Nihon University (JP), Kyushu University (JP), Shinshu University (JP), Shimane University (JP), Kawasaki Medical School (JP), Tohoku University (JP), Akita University (JP), Tokyo Metropolitan Komagome Hospital (JP), University of Shimane (JP), University of Tokyo Hospital (JP), Kameda Medical Center (JP), Harasanshin Hospital (JP), Kawasaki Medical School Hospital (JP), Aizawa Hospital (JP), Showa Inan General Hospital (JP), Yamagata University Hospital (JP), Yuri Kumiai General Hospital (JP), Omagari Kousei Medical Center (JP), Hokkaido Cancer Society (JP), NTT Medical Center Sapporo (JP), Yamagata Saisei Hospital (JP)
Akita University
Good health and well-being
Openalex Percentile: Top 10%
Esophageal Cancer Research and Treatment
DOIOpen Access PDFOpenAlex
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