Background and Aims
The role of endoscopic submucosal dissection (ESD) in Barrett’s early neoplasia is
not well defined, with most studies originating from Asia and Europe. We aimed to
assess the efficacy, safety, and results of ESD in Barrett’s esophagus (BE) with high-grade
dysplasia (HGD) and early adenocarcinoma (EAC) across centers in the United States.
Methods
Multicenter retrospective analysis on 46 patients with BE who underwent ESD for BE-HGD
or EAC, or both, between January 2010 and April 2015. The primary endpoint was the
rate of en bloc resection. Secondary aims included rate of R0 (complete) and curative
resection, a comparison of pre- and post-ESD histology, procedure-related adverse
events, and rate of remission at follow-up.
Results
Median age was 69 years (range, 42-82 years). The median resected specimen size was
45 mm (range, 13-125 mm). En bloc and curative resection rates were 96% (44/46) and
70% (32/46), respectively. Most lesions (11/20; 55%) diagnosed as BE-HGD on biopsy
were upstaged to intramucosal or invasive EAC on post-ESD histopathology. There were
4 early (<48 hours) adverse events (3 bleeding and 1 perforation), and all were treated
endoscopically. Seven patients (15%) developed esophageal strictures that were managed
endoscopically. Complete remission of BE neoplasia was found in 100% (32/32) of patients
with curative resection at median follow-up of 11 months (range, 2-25 months).
Conclusions
This is the largest multicenter series of ESD for early neoplastic BE from the United
States. ESD appears to be safe and effective, with high en bloc and curative resection
rates in the treatment of early BE neoplasia.
Abbreviations:
BE (Barrett’s esophagus), EAC (early adenocarcinoma), EGJ (gastroesophageal junction), EMR (endoscopic mucosal resection), ESD (endoscopic submucosal dissection), EUS (endoscopic ultrasound), HGD (high-grade dysplasia)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 26, 2016
Accepted:
September 18,
2016
Received:
May 18,
2016
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 731.
Identification
Copyright
© 2017 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- Endoscopic submucosal dissection learning curve and role in the treatment of Barrett's neoplasiaGastrointestinal EndoscopyVol. 87Issue 4
- PreviewWe read with interest the articles by Yang et al1 and by Subramaniam et al2 on the role of endoscopic submucosal dissection (ESD) for the treatment of neoplastic Barrett’s esophagus (NBE). Conventional multimodal endoscopic treatment has some limitations, such as recurrence of neoplasia and intestinal metaplasia in 4% and 8% of cases, respectively, and adverse events in 19% of patients.3
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