The standard of care for nonsuperficial T1b esophageal adenocarcinoma (EAC) is esophagectomy. However, esophagectomy is associated with increased morbidity and mortality. The role of endoscopic resection (ER) and adjuvant therapy for T1b EAC has not been adequately investigated. We compared survival outcomes in patients with T1b esophageal adenocarcinoma undergoing various treatment modalities. The National Cancer Database was queried for patients with T1b EAC diagnosed from 2010 to 2015 undergoing esophagectomy, ER with or without ablation, ER with radiation therapy with or without chemotherapy, and definitive chemoradiation. Patients with nodal or metastatic disease were excluded. Multivariable Cox regression and propensity score matching were used to adjust survival analyses for clinical and demographic covariates. Patients were stratified by age, sex, race, grade, Charlson-Deyo comorbidity index, and tumor size. Overall, 615 patients with T1b EAC met inclusion criteria. Patients were divided into four treatments groups: esophagectomy (n=477; 78%), ER with or without ablation (n=96; 16%), ER with radiation therapy with or without chemotherapy (n=24; 3.9%), and definitive chemoradiation (n=13; 2.1%). On multivariate analysis esophagectomy did not result in improved OS compared to ER with or without ablation (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 0.79-1.90, P = 0.36), ER with radiation with or without chemotherapy (HR=0.97, 95% CI 0.45-2.09, P=0.94), or definitive chemoradiation (HR=1.52, 95% CI 0.60-3.82, P=0.38). Covariates including age, sex, race, grade, Charlson-Deyo comorbidity index, and tumor size were not significantly associated with survival. There was no significant difference in survival between T1b esophageal adenocarcinoma patients undergoing various treatment options compared to esophagectomy alone. Thus, ER may be a reasonable alternative treatment to esophagectomy in these patients. Factors that have been known to be associated with improved survival in esophageal cancer, such as lower grade, smaller size, and younger age, may not have as much of an impact on T1b esophageal cancer patients given its early stage. Further studies are needed specifically in this population to investigate optimal therapeutic strategies that improve outcomes while minimizing toxicity.