Neoplastic risk in hyperplastic esophagogastric junction lesions: a comprehensive multicenter study

Introduction: Esophagogastric junction (EGJ) lesions are uncommon and histologically diverse. Among these, EGJ hyperplastic lesions are rare and generally considered benign. However, their nonspecific appearance makes accurate endoscopic identification challenging. Endoscopic resection is both a diagnostic and therapeutic approach, yet the risk factors for neoplastic transformation in EGJ lesions remain unclear. This study aimed to identify predictive factors for neoplastic transformation in hyperplastic EGJ lesions. Methods: This multicenter, retrospective study included patients with hyperplastic EGJ lesions endoscopically resected across 13 European hospitals. Data were collected from endoscopy and pathology reports. Neoplastic transformation was defined by the presence of dysplasia or adenocarcinoma. A multivariable logistic regression model was conducted to assess predictive factors for neoplastic transformation in resected hyperplastic lesions. Results: From January 2015 to October 2024, 91 EGJ hyperplastic lesions were included. Polypectomy/endoscopic mucosal resection (EMR) was performed in 86% of cases, endoscopic submucosal dissection (ESD) in 19%. En bloc resection was successfully achieved in 93% of cases, while R0 resection rates were confirmed in 84% of cases. Twenty-one lesions (23%) showed a neoplastic transformation at histology. Independent predictive factors for neoplastic transformation in hyperplastic lesions included non-polypoid morphology (OR 5.48; p = 0.025), presence of surface ulceration (OR 11.5; p = 0.0005) and lesion size (OR 5.48; p = 0.021). A lesion size greater than 12 mm was identified as a significant predictor of neoplastic transformation in hyperplastic lesions. Conclusions: EGJ hyperplastic lesions showed a non-negligible risk of neoplastic transformation. These findings highlight the need for careful endoscopic assessment to predict malignancy while promoting appropriate management strategies to ensure adequate R0 resections in cases of undetected local malignancy.