Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett's oesophagus: acute-phase and intermediate results of a new treatment approach

Abstract

These good acute-phase and intermediate results, along with low morbidity rates and no mortality, suggest that the organ-preserving local endoscopic procedure including EMR and PDT is an attractive alternative to oesophageal resection. Therefore, endoscopic therapy might replace radical oesophageal resection in future in cases of intraepithelial high-grade neoplasia and early mucosal adenocarcinoma in Barrett's oesophagus.

Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection

“…7,8 After focal ER of HGD/EC, the residual BE still holds the potential of malignant degeneration, and metachronous lesions occur in 30% of patients. 9 Additional treatment of the residual BE after focal ER is therefore advocated, and different treatment modalities have been proposed for this end. The residual BE may be completely removed with stepwise radical endoscopic resection (SRER).…”

Endoscopic mucosal resection in the upper gastrointestinal tract

“…Metachronous or recurrent lesions were seen in 23% of the patients at a mean follow-up period of 34 ± 10 mo. Amongst the patients treated with EMR alone, 6/28 patients (21.4%) developed metachronous or recurrent lesions, compared to 1/6 patients (16.6%) treated with combined modalities [59] . In a follow-up study of a total of 115 patients (EMR = 70, PDT = 32, APC = 3, EMR + PDT = 10) undergoing endoscopic treatment for HGD or EC, there was a 31% rate of metachronous or recurrent lesions over an average follow-up time of 34 ± 10 mo.…”

“…Although EMR has a clear role in squamous cell carcinoma, its role in BE is not clearly defined, although studies have determined that EMR is effective in removing visible lesions in BE [24,30,55] . In fact, current evidence suggests that EMR of high-grade dysplasia (HGD) and early cancer (EC) has similar success rates as surgical treatment [56][57][58][59][60] . According to Ell et al, the indications for EMR in the setting of Barrett's neoplasia include the following: lesions limited to the mucosa that are macroscopically flat, tumor size between 20-30 mm, and good to moderate differentiation on histology [56] .…”

“…In addition, EMR changed the pretreatment diagnosis in 25.6% of the studied patients [62] . Recurrence of neoplastic disease after EMR is a potential limitation [56,59] . Therefore, circumferential resection, in which the targeted dysplastic lesion and the surrounding Barrett's mucosa are removed, has also been studied [63] .…”

“…In fact, a recently-published multicenter, randomized controlled trial has shown that photodynamic therapy with Photofrin is superior than omeprazole alone in eliminating HGD at 5 years follow-up (77% vs 39%, respectively) [69] . To improve eradication of neoplastic tissue and decrease recurrence rates, the combined use of EMR with ablative techniques have been described [59,70] . Theoretically, recurrence rates are expected to be much lower with combined modalities, because both visible and non-visible lesions would be eradicated.…”