For a study, the researchers sought to compare the outcomes of endoscopic resection (ER) vs esophagectomy in patients with node-negative esophageal adenocarcinoma in the cT1a and cT1b stages. The usefulness of ER in the treatment of clinical T1N0 esophageal adenocarcinoma subtypes remains debatable. Patients with clinical T1aN0 (n=2545) and T1bN0 (n=1281) esophageal adenocarcinoma who got either ER (cT1a, n=1581; cT1b, n=335) or esophagectomy (cT1a, n=964; cT1b, n=946) were identified using data from the National Cancer Database (2010–2015). To control treatment selection bias, propensity score matching and Cox analyses were performed. Over time, ER for cT1a and cT1b illnesses became more widespread. Patients with cT1a and cT1b esophageal adenocarcinoma had a rate of node-positive disease of 4% and 15%, respectively. ER exhibited similar survival to esophagectomy in a matched sample of cT1a malignancies [hazard ratio (HR): 0.85, 95% CI: 0.70–1.04, P=0.1]. The 5-year survival rates for ER and esophagectomy were 70% and 74%, respectively (P=0.1). Overall survival for cT1b malignancies was not statistically different between the therapy groups (HR: 0.87, 95% CI: 0.66–1.14, P=0.3). The 5-year survival rates for ER and esophagectomy were 53% and 61%, respectively (P=0.3). For clinical T1aN0 and T1bN0 esophageal adenocarcinoma, the study shows that ER has comparable long-term outcomes. However, the positive nodal disease was detected in 15% of cT1b esophageal cancer patients. Future studies should focus on identifying the subset of T1b tumors at high risk of nodal metastases and benefit from esophageal lymphadenectomy.