Risk factors for serious adverse events associated with multiband mucosectomy in Barrett’s esophagus: an international multicenter analysis of 3827 endoscopic resection procedures

Belghazi, Kamar; Marcon, Norman E.; Teshima, Christopher; Wang, Kenneth K.; Milano, Reza V.; Mostafavi, Nahid; Wallace, Michael B.; Kandel, Pujan; Perez, Lady Katherine Mejia; Bourke, Michael J.; Bahin, Farzan F.; Everson, Martin; Haidry, Rehan; Ginsberg, Gregory G.; Gene, K.; Koch, Arjun D.; Ragunath, Krish; Ortiz-Fernández-Sordo, Jacobo; Pietro, Massimiliano di; Seewald, Stefan; Weusten, Bas L.; Schoon, Erik J.; Bisschops, Raf; Bergman, Jacques; Pouw, Roos E.

doi:10.1016/j.gie.2020.03.3842

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…The BECs adhered to a common treatment and follow-up protocol, and several meetings a year were held to further guarantee homogeneity. Apart from this close collaboration for clinical care, a solid joint research infrastructure was founded and resulted in multiple publications in the field of pathology [13][14][15][16] , imaging [17][18][19] , and treatment 8,9,[20][21][22][23][24][25][26] of early BE neoplasia.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

Munster

Nieuwenhuis

Weusten

et al. 2021

Journal of Gastrointestinal Surgery

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Introduction After endoscopic resection (ER) of neoplasia in Barrett’s esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. Methods Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. Results Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11–51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. Conclusion In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.

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Section: Methodsmentioning

confidence: 99%

Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

Munster

Nieuwenhuis

Weusten

et al. 2021

Journal of Gastrointestinal Surgery

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“…Endoscopic resection of early neoplasia in Barrett's esophagus (BE) is mostly performed using the multiband mucosectomy technique. Multiple large studies have shown that this technique is a safe and effective treatment for early BE neoplasia (i. e., ≤ sm1) [1,2]. A technical limitation of using this approach is that lesions larger than 20 mm must be removed using multiple adjacent resections in a so-called piecemeal fashion.…”

Section: Introductionmentioning

confidence: 99%

“…A technical limitation of using this approach is that lesions larger than 20 mm must be removed using multiple adjacent resections in a so-called piecemeal fashion. For early BE neoplasia (i. e., low grade dysplasia [LGD], high grade dysplasia [HGD]), or esophageal adenocarcinoma [EAC] limited to the superficial submucosa [m1-sm1]), piecemeal resection is an adequate approach [1,2].…”

Section: Introductionmentioning

confidence: 99%

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

et al. 2021

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Objective The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett’s esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed inNL. Design We retrospectively assessed ESD outcomes in NL, where treatment for BE neoplasia is centralized in 9 expert centers with jointly trained endoscopists and pathologists, and treatment/follow-up data collected in a joint database. ESD is restricted for selected cases. Results During median 121 minutes (p25-p75 90-180), 130 complete ESDs were performed with 97% (126/130) removed en-bloc. Pathology was HGD (5%), T1a-EAC (43%) or T1b-EAC (52%; 19%sm1, 33%≥sm2). The combined en-bloc and R0 rate was 87% [95%-CI 77-94%] for HGD/T1a-EAC and 49% [37-62%] for T1b-EAC. Upon R1 resection, 29% had residual cancer, in all cases detected at first follow-up endoscopy, while the remaining 71% had no residual cancer in esophagectomy specimen (n=6) or during median 9 months endoscopic FU (p25-p75 4-22) (n=18). Upon R0 resection, local recurrence rate during median 17 months (8-30) was 0% [0-5%]. Adverse events: 1% perforation [0-4%], 3% post-procedural bleeding [1-7%], 13% strictures [8-20%]. Conclusion In expert hands, ESD is safe and allows for removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter is, however, associated with a positive deep resection margin in half of the patients, yet only one third had actual persisting neoplasia at endoscopic FU. To better stratify R1-patients with an indication for additional surgery, repeat endoscopy after healing of the ESD wound may help in predicting residual cancer.

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“…Even after an incomplete resection by EMR, radiofrequency ablation can efficiently complete the treatment, also on intramucosal adenocarcinoma, as found by Haidry et al in 2015 [ 47 ]. Likewise, in an international multicenter retrospective study evaluating the safety of EMR for early EA in 3827 endoscopic resections, Belghazi et al found a 0.4% perforation rate and 0.9% post-procedural bleedings [ 48 ]. Finally, the only randomized controlled study comparing EMR to ESD in EA did find significant differences in terms of endoscopic and histological outcomes (R0 resection rate of 59% vs. 12%, curative resection rate of 53% vs. 12%); but the overall survival and local recurrence rates were not statistically different.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early esophagogastric junction adenocarcinomas: a systematic review

Doumbe-Mandengue

Pellat

Terris

et al. 2022

aog

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Background Esophagogastric junction adenocarcinomas (EGJAs) include esophageal and gastric cardia adenocarcinomas (GCAs). These tumors are currently regarded as a single entity, with similar surgical and oncological therapies, although they originate from different organs. Endoscopy allows an early-stage diagnosis, where both subtypes can be differentiated. With this review we aimed to describe the outcomes of endoscopic submucosal dissection for the treatment of esophageal adenocarcinomas (EAs) and GCAs. Methods We identified studies by screening PubMed, Embase and Web of Science. We included all 19 studies that mentioned at least one of the following criteria of interest: en bloc ; R0 resection; local recurrences; and/or overall survival. Results We found an en bloc resection rate superior to 90% for both tumors. R0 resections rates were over 60% for most EAs, vs. 83% for most GCAs. We recorded less than 13% and 20% early and late adverse events for EA, and 10% and 7% for GCA. The local recurrence rate was 8% for EA and 3% for GCA. The overall survival was over 90%. Conclusions Endoscopic submucosal dissection is safe and effective for esophageal and GCAs. These data support the extension of the use of endoscopic submucosal dissection to all EGJAs, including early EAs.

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Risk factors for serious adverse events associated with multiband mucosectomy in Barrett’s esophagus: an international multicenter analysis of 3827 endoscopic resection procedures

Cited by 9 publications

References 27 publications

Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

Endoscopic submucosal dissection for early esophagogastric junction adenocarcinomas: a systematic review

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