Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States

Yang, Dennis; Coman, Roxana M.; Kahaleh, Michel; Waxman, Irving; Wang, Andrew Y.; Sethi, Amrita; Shah, Ashish; Draganov, Peter V.

doi:10.1016/j.gie.2016.09.023

Cited by 93 publications

(86 citation statements)

References 38 publications

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“…EUS has been reported as unreliable in staging T2N0M0 cancers (19,20); therefore, for cT1N0M0 and cT2N0M0 cancers, additional information is needed for decision-making. For T1N0M0 cancers, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are highly effective in confirming EUS cT1N0M0 and differentiating cT1a from cT1b (18,(21)(22)(23). Note that pathologically confirmed T1 by EMR remains cT1, not pT1 (24).…”

Section: Histologic Cell Typementioning

confidence: 99%

See 1 more Smart Citation

8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice

Rice¹,

Patil²,

Blackstone³

2017

Ann. Cardiothorac. Surg.

558

405

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Section: Histologic Cell Typementioning

confidence: 99%

“…Tumors that are likely to demonstrate submucosal invasion are larger than 15 mm or poorly "lifting" (22). Similar to EMR specimens, the tissue orientation in ESD specimens facilitates the crucial distinction between pT1a and pT1b cancer (23).…”

Section: Handling Of Resection Specimenmentioning

confidence: 99%

8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice

Rice¹,

Patil²,

Blackstone³

2017

Ann. Cardiothorac. Surg.

558

405

View full text Add to dashboard Cite

“…Most early Barrett's neoplasia can be adequately treated by EMR to remove all visible abnormalities followed by eradication of the remaining flat Barrett's esophagus with radiofrequency ablation . Larger lesions (≥15 mm) usually require piecemeal EMR . Complete endoscopic resection (CER) of short‐segment Barrett's neoplasia including high‐grade dysplasia (HGD) or early adenocarcinoma, by 2–3 stage radical band mucosectomy is an effective, safe and durable treatment, with complete remission of neoplasia achieved in 98% of patients after mean follow up of 40 months .…”

Section: Role Of Esd: Comparing Outcomes For Early Gastrointestinal Tmentioning

confidence: 99%

Endoscopic submucosal dissection in the West: Current status and future directions

Michael

Bourke

2017

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in Eastern countries is significant, and excellent outcomes from high-volume centers are reported. The potential benefits of ESD are recognized by Western endoscopists, but its adoption has been limited. A number of factors contribute to this, including epidemiological differences in GIT neoplasia between Western and Eastern populations and limitations in training opportunities. In this review, we discuss the role of ESD, its current status and the future in Western endoscopic practice.

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“…Our results add to the evidence that supports the use of ESD for the treatment of Barrett's neoplasia . The nature of EMR limits the endoscopist's ability to accurately and consistently control the depth of resection and ESD has been suggested as an alternative that allows for better visualization of depth of both the lesion and resection plane . Unfortunately, direct comparisons between ESD and EMR for the treatment of Barrett's neoplasia are limited to relatively small studies or extrapolations from treatment of superficial squamous cell carcinoma of the esophagus .…”

Section: Discussionmentioning

confidence: 73%

Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett's‐related neoplasia

Podboy

Kolahi

Friedland

et al. 2019

Digestive Endoscopy

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Background & Aims Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have demonstrated similar efficacy in removal of neoplastic esophageal lesions. However, significant controversy exists over the preferred resection technique. Our primary aim was to compare the pathologic specimens produced via EMR and ESD and secondarily gauge their effect on clinical decision making and patient outcomes. Methods Using a retrospective cohort study design, all esophageal Barrett's‐associated neoplastic lesions resected by a single provider from 2012 to 2017 were reviewed. The pathology was re‐reviewed by two blinded authors for diagnosis, margins, and adverse outcomes and recurrence rates were also collected. Results Thirty‐one EMR and 20 ESD cases were identified. Baseline demographics and lesion characteristics were similar. ESD produced more R0 resections and more en bloc resections compared to EMR. EMR produced more equivocal lateral (13/31, 41.9% vs 1/20, 5.0%) and vertical margins (13/31, 41.9% vs. 0/20, 0%, both P < 0.05). This led to an inability to reach a definitive diagnosis in 13/31 EMR vs 0/20 ESD pathology specimens (P = 0.003). Of the 13 EMR specimens with equivocal pathology, 11 were noted to have ‘at least intramucosal adenocarcinoma’. Four of the 11 patients chose to undergo elective esophagectomy with final surgical pathology demonstrating ≤T1a disease in 2, and ≥T1b disease in two. Conclusion Compared to ESD, EMR was associated with greater pathologic uncertainty in Barrett's‐associated neoplasia.

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Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States

Cited by 93 publications

References 38 publications

8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice

8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice

Endoscopic submucosal dissection in the West: Current status and future directions

Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett's‐related neoplasia

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