295. RELATIONSHIP BETWEEN ABDOMINAL FAT DISTRIBUTION AND PROGRESSION OF BARRETT’S ESOPHAGUS TO ADENOCARCINOMA

Abstract Background Obesity was known to be a risk factor of the incidence of Barrett’s esophagus (BE) and Barrett’s esophageal adenocarcinoma (BEA). Especially excessive visceral fat has recently reported to promote some cancers, including BEA. This study aimed to clarify the impact of abdominal fat distribution on the progression of BE to adenocarcinoma in long-segment BE (LSBE) and short-segment BE (SSBE). Methods Study 1: We retrospectively reviewed the 124 patients with pathologically defined superficial BEA who underwent endoscopic resection, including 4 endoscopic mucosal resection (EMR) and 85 endoscopic submucosal dissection (ESD), or surgical operation (35 esophagectomy) in our institution between January 2004 and December 2018. 124 BEA cases included 34 LSBE (length ≥ 3 cm) cases and 90 SSBE (length ≥ 1 and < 3 cm) cases. Using computed tomography volumetry, we measured areas of visceral (VFA) and subcutaneous (SFA) fat at the level of the umbilicus, and calculated the VFA/SFA ratio in each patient, defining high-VFA/SFA ratio (≧1.0) and low-VFA/SFA ratio (<1.0). VFA/SFA ratio were compared and analyzed between BEA with LSBE group and BEA with SSBE group. Study2: We divided 62 patients who had LSBE into two groups based on prognosis of BEA; BEA with LSBE (34 patients) and non-BEA with LSBE group (18 patients). Abovementioned parameters were compared and analyzed between these two groups. Study3: Abovementioned parameters were compared and analyzed between BEA with SSBE (90 cases) and non-BEA with SSBE group (100 controls). Results study1: High VS ratio were seen in 22 (64.7%) patients among BEA with LSBE group and 34 (37.8%) patients among BEA with SSBE group, which is statistically significant (p = 0.0072). Study2: High VS ratio were seen in 6 (33.3%) patients among non-BEA with LSBE group. This result was statistically significant compared to BEA with LSBE group (0.038). Study3: In non-BEA with SSBE, 32 patients (32.0%) had High VS ratio, showing no significant difference compared to BEA with SSBE. Conclusion High VFA/SFA ratio was significantly associated with progression of long-segment Barrett’s esophagus to esophageal adenocarcinoma.