Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients

Background

EMR is typically used to remove focal abnormalities of the esophageal mucosa. However, larger areas of Barrett's esophagus (BE) can be resected through side-by-side resections.

Objective

To assess the efficacy and safety of EMR to completely remove BE.

Design

Retrospective, single-center study.

Setting

University of Iowa Hospitals and Clinics.

Patients

Between January 2006 and December 2010, 46 patients underwent EMR for complete removal of BE. Three were lost to follow-up, one died of unrelated causes before completion, and one was still undergoing EMR treatment at the conclusion of the study. The remaining 41 patients were included for analysis. The worst histologic grade was low-grade dysplasia in 4 patients, high-grade dysplasia without cancer in 26 patients, and high-grade dysplasia with superficial adenocarcinoma in 11 patients. BE was circumferential in 65.9% of cases, and the mean (± SD) length was 3.3 ± 2.3 cm.

Intervention

EMR was performed by using a cap (n = 4), a multiband ligator device (n = 31), or both (n = 6), with a mean (± SD) of 2.4 ± 1.2 sessions per patient.

Main Outcome Measurements

Remission rates and complications.

Results

Remission of high-grade dysplasia and cancer, all dysplasia, and all BE was achieved in 94.6%, 85.4%, and 78.0%, respectively. Complications included minor bleeding (31.7%), perforations (4.9%), and strictures (43.9%). All complications were managed conservatively.

Limitations

Retrospective design.

Conclusion

Complete removal of BE with EMR is effective but associated with a high complication rate, which is mainly related to stricture formation. This needs to be considered when choosing between available treatment modalities.

Abbreviation: BE, Barrett's esophagus, BLMR, band ligator–assisted mucosal resection, CAMR, cap-assisted mucosal resection, LSBE, long-segment BE, SSBE, short-segment BE