Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma

Bahin, Farzan F.; Jayanna, Mahesh; Hourigan, Luke F.; Lord, Reginald V.; Whiteman, David C.; Lee, Eric Y.T.; Bourke, Michael J.

doi:10.1016/j.gie.2015.04.044

Cited by 30 publications

(34 citation statements)

References 47 publications

(63 reference statements)

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“…We did not observe a high complication rate as reported for radical complete endoscopic resection in other studies (Table 3; 4 10 20 21 22 23 24), and we explain our favorable outcome by the low number of resections per endoscopic session; a maximum of two band ligation resections were performed and we avoided overlapping resections when possible. If overlapping resections were required, we tended to resect more proximal or distal to the mucosal defect rather than horizontally at the same distance from the incisors.…”

Section: Discussionsupporting

confidence: 45%

“…Other EMR studies have followed intensified protocols, offering shortened intervals for repeat EMR at 6 – 8 weeks 23. Although the optimum interval for a repeat procedure is unclear, we find that repeating 3-monthly gastroscopies/EMRs is sufficient, since it does not lead to an increased rate of metachronous cancers in short segment Barrett’s and allows the ligation ulcers to heal.…”

Section: Discussionmentioning

confidence: 68%

“…Performing only three resections per session showed lower stricture rates of 33 % 21 22. If complete endoscopic resection of a short Barrett’s segment (C < 3 cm, M < 5 cm) is achieved in a radical approach within a median of two EMR sessions, the proportion of patients requiring dilatation of a stricture was 36.8 % 23.…”

Section: Discussionmentioning

confidence: 96%

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Non-radical, stepwise complete endoscopic resection of Barrett’s epithelium in short segment Barrett’s esophagus has a low stricture rate

et al. 2016

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Background and aims: Radical endoscopic excision of Barrett’s epithelium performing 4 – 6 endoscopic resections during the same endoscopic session results in complete Barrett’s eradication but has a high stricture rate (40 – 80 %). Therefore radiofrequency ablation is preferred after endoscopic mucosal resection (EMR) of visible nodules. We investigated the clinical outcome of non-radical, stepwise endoscopic mucosal resection with a maximum of two endoscopic resections per endoscopic session. Methods: We analysed our prospectively maintained database of patients undergoing esophageal EMR for early neoplasia in Barrett’s esophagus from 2009 to 2014. EMR was performed using a maximum of two band ligation mucosectomies per endoscopic session; thereafter, follow-up was 3-monthly and EMR was repeated as required for Barrett’s eradication. Results: In total, 118 patients underwent staging EMR for early Barrett’s neoplasia. Subsequently, 27 patients underwent surgery/chemotherapy due to deep submucosal or more advanced tumor stages or were managed conservatively. The remaining 91 patients with high grade dysplasia (48), intramucosal (38) or submucosal cancer (5) in the resected nodule underwent further endoscopic therapy with a mean follow-up of 24 months. Remission of dysplasia/neoplasia was achieved in 95.6 % after 12 months treatment. Stepwise endoscopic Barrett’s resection resulted in complete Barrett’s eradication in 36/91 patients (39.6 %) in a mean of four sessions; 40/91 patients (44.0 %) had a short circumferential Barrett’s segment (< 3 cm). In this group, repeated EMR achieved complete Barrett’s excision in 85.0 %. One patient developed a stricture (1.1 %), one a delayed bleeding, and there were no perforations. Conclusion: In patients with a short Barrett’s segment, non-radical endoscopic Barrett’s resection at the time of scheduled endoscopy follow-up allows complete Barrett’s eradication with very low stricture rate.

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 68%

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Non-radical, stepwise complete endoscopic resection of Barrett’s epithelium in short segment Barrett’s esophagus has a low stricture rate

et al. 2016

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“…There are multiple studies on the efficacy, durability, and safety of s‐EMR that demonstrate rates of complete eradication of neoplasia (CE‐N) and complete eradication of intestinal metaplasia (CE‐IM) of 80–100% and 76–94%, respectively with mean or median follow up of 17–55 months (Table ) . In contrast, s‐EMR is associated with a high rate of esophageal stricture formation, which occurs in 2–88% of patients depending on the extent of the resection and number of treatment sessions, as well as a 1–5% risk of perforation . A recent study reporting long‐term outcomes with s‐EMR demonstrated CE‐N and CE‐IM were achieved in 89% and 71% of patients, respectively, at a mean follow‐up time of 41 months.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

“…A recent study reporting long‐term outcomes with s‐EMR demonstrated CE‐N and CE‐IM were achieved in 89% and 71% of patients, respectively, at a mean follow‐up time of 41 months. Esophageal dilation was required in 37%; however, 96% of patients had no or minimal dysphagia and 91% of patients found radical EMR an acceptable treatment . Despite the increased risk of stricture formation, complete endoscopic resection offers distinct advantages over f‐EMR by enabling a more complete and thorough histological examination of the entire BE segment, which may harbor synchronous lesions that are not visible and, therefore, leave the patient at risk for future development of metachronous neoplasia within the remaining BE.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

Endoscopic treatment of Barrett's esophagus: What can we learn from the Western perspective?

Shimamura

Iwaya

Goda

et al. 2017

Digestive Endoscopy

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The incidence of Barrett's esophagus (BE)-related neoplasia in Western countries has increased in the past several decades and, even in Eastern countries, it appears to be increasing. Endoscopic therapies are the first-line treatment for BE-related neoplasia; however, there is still no standardized treatment strategy. Most of the data have been published from Western countries where the ultimate goal of treatment is complete eradication of BE mucosa removing subtle synchronous lesions and preventing metachronous neoplasia. A multimodality approach that combines endoscopic resection and radiofrequency ablation (RFA) has been widely accepted in the West. In contrast, the lack of access to RFA treatment in the East has meant that endoscopic resection is the only feasible option. There is a wide divergence in treatment strategies for BE-related neoplasia between the East and the West. It is very important to consider these basic differences in the context of the currently available evidence to date. Therefore, the purpose of this article is to review the recent literature and to provide an overview of the endoscopic treatment options for BE.

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Endoscopic Therapy for Superficial Esophageal Cancer

Lipowska

Waxman

2018

Esophageal Cancer

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Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma

Cited by 30 publications

References 47 publications

Non-radical, stepwise complete endoscopic resection of Barrett’s epithelium in short segment Barrett’s esophagus has a low stricture rate

Non-radical, stepwise complete endoscopic resection of Barrett’s epithelium in short segment Barrett’s esophagus has a low stricture rate

Endoscopic treatment of Barrett's esophagus: What can we learn from the Western perspective?

Endoscopic Therapy for Superficial Esophageal Cancer

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