P1.119. Oesophageal Squamous Dysplasia Disease Spectrum: Patterns of Progression and Management in a Single-Centre Experience

Abstract

Abstract Topic Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Background Oesophageal squamous dysplasia represents a heterogeneous spectrum of disease ranging from atypia and low-grade dysplasia to high-grade dysplasia (HGD), squamous cell carcinoma in situ (SCCis), and invasive squamous cell carcinoma (SCC). The optimal management strategy remains uncertain because of the variable risk of progression. Methods Methodology: A retrospective review of all patients managed for oesophageal squamous dysplasia and early squamous neoplasia at a tertiary referral centre was undertaken. Demographic characteristics, histopathology, treatment modality, disease progression, and surveillance outcomes were analysed. Results: Results Twenty-two patients were identified with a median age of 72.5 years (range 40–85). Histology included squamous atypia, moderate dysplasia, HGD, SCCis, and invasive SCC. Initial management strategies comprised surveillance with endoscopic surveillance, endoscopic mucosal resection (EMR; n=6), endoscopic submucosal dissection (ESD; n=2), radiofrequency ablation (RFA; n=2), chemoradiotherapy (n=3), radiotherapy alone (n=2), and oesophagectomy (n=5). Disease progression occurred in seven patients, with progression from dysplasia or HGD to SCCis or invasive SCC. Three patients subsequently developed metastatic disease. Among those undergoing oesophagectomy for presumed dysplasia or SCCis, pathological upstaging to invasive SCC occurred despite initial biopsies demonstrating dysplasia alone. Endoscopic therapy achieved disease control in selected patients, although recurrent dysplasia, stricture formation, and progression despite treatment were observed, particularly in multifocal or extensive lesions. Conclusion: Conclusion Oesophageal squamous dysplasia carries a substantial risk of progression to invasive carcinoma. Early multidisciplinary assessment, close surveillance, and timely definitive intervention are required, particularly in patients with multifocal or high-grade disease.