EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett's esophagus

Larghi, Alberto; Lightdale, Charles J.; Memeo, Lorenzo; Bhagat, Govind; Okpara, Nnenna; Rotterdam, Heidrun

doi:10.1016/s0016-5107(05)00319-6

Cited by 194 publications

(109 citation statements)

References 32 publications

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“…However, SM invasion was seen on ER-L specimens in 8 of 26 (30%) patients with IMCA on biopsy and EUS. Similar results have been noted in other series [Larghi et al 2005;Nijhawan et al 2000].…”

Section: Histopathology Examinationssupporting

confidence: 92%

“…In contrast, patients with HGD and T1m disease have negligible risk of concurrent lymph node metastasis and no greater than that of mortality associated with operative esophagectomy [Enzinger and Mayer, 2003]. Endoscopic therapy has shown considerable promise as a minimally invasive approach to patients with HGD and T1m cancer [Ell et al 2007;Larghi et al 2005;Soetikno et al 2003;Pech et al 2003]. Accurate staging is therefore critical when considering the management options for patients with BE and HGD/IMCA.…”

Section: Histopathology Examinationsmentioning

confidence: 99%

“…ER holds an advantage over ablative therapies because it provides a histopathological specimen and is particularly useful for the evaluation and management of nodular Barrett's [Larghi et al 2005]. Compared to forceps biopsy tissue sampling alone, ER leads to a change in histopathology stage in up to 40% of instances [Ginsberg, 2003;Nijhawan and Wang, 2000].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma

Bhat

Furth

Brensinger

et al. 2009

Therap Adv Gastroenterol

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Abstract:Background: Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving. Endoscopic resection has an increasing role. We wanted to evaluate the safety and efficacy of multi-band ligation/resection [ER-L] without pre-injection in BE with high-grade dysplasia [HGD] and intramucosal carcinoma [IMCA]. Methods: A cohort of 65 consecutive patients from a single academic medical center, who underwent ER-L as part of endoscopic eradication therapy for BE with HGD/IMCA were studied. ER-L was performed after endoscopic mapping and endoscopic ultrasound (EUS). Subsequently, adjunctive ablative therapies including photodynamic therapy, argon plasma coagulation and radiofrequency ablation were applied to achieve complete eradication of all BE. Thereafter biopsy surveillance was performed per protocol. All patients were prescribed a proton-pump inhibitor. Main outcome measurements: Change in histopathological stage; eradication of BE and HGD/IMCA; adverse events. Results: The median number of ER-L applications in each session was 4 (range 16) and the mean total number of ER-L sessions was 1.5. Compared with prior forceps biopsy, histopathology from the ER-L specimen changed in 24 (37.5%, p ¼ <0.0001). With median follow-up of 15 months (range 842), complete and durable BE eradication was achieved with ER-L alone in 36 (60%) and the remainder with adjunctive ablation therapies. There were nine complications (four (6%) acute bleeding, five (7.5%) strictures, zero perforations). Conclusions: ER-L without submucosal (SM) pre-injection is safe and effective when applied selectively for eradication of BE with HGD/IMCA. There is significant change in pathological stage after ER-L conferring a diagnostic and staging advantage. ER-L may be used adjunctively with ablation therapies.

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Section: Histopathology Examinationssupporting

confidence: 92%

Section: Histopathology Examinationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma

Bhat

Furth

Brensinger

et al. 2009

Therap Adv Gastroenterol

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“…While Barrett's esophagus affects only the mucosal layer, high-grade dysplasia and subsequent carcinoma may involve deeper layers of the esophagus and possibly paraesophageal lymph nodes [10]. Often, the histologic distinction of high-grade dysplasia and carcinoma cannot be made and thus EUS offers excellent visualization of the esophageal layers and paraesophageal lymph nodes to identify advanced disease [11,12] EUS has been shown to have an accuracy of 85% in staging of high-grade dysplasia and early esophageal cancer with regard to depth and invasion into layers beneath the mucosa [13,14]. Furthermore, suspicious lymph nodes can be identified.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

Sreenarasimhaiah¹

2014

J Gastroint Dig Syst

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“…Endoscopic mucosal resection (EMR) is one such treatment option, which is increasingly being used to cure HGD and IMCA [2,5,8,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Depth of resection using two different endoscopic mucosal resection techniques

et al. 2008

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Background and study aims-Endoscopic mucosal resection (EMR) has been carried out for high-grade dysplasia (HGD) and intramucosal carcinoma (IMCA) in Barrett's esophagus using two different cap-assisted techniques, the "inject, suck, and cut" and the "band and snare. " Previous work has demonstrated comparable specimen diameters. However, the two techniques have not been previously compared with respect to depth of resection.

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EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett's esophagus

Cited by 194 publications

References 32 publications

Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma

Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

Depth of resection using two different endoscopic mucosal resection techniques

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