Background and Aims
Multiband mucosectomy (MBM) is a widely used technique for the treatment of Barrett’s
esophagus (BE). However, large multicenter studies enabling a generalizable estimation
of the risk of serious adverse events, such as perforation and postprocedural bleeding,
are lacking. The aim of this study was to estimate the rate of, and risk factors for,
serious adverse events associated with MBM.
Methods
In this retrospective analysis, consecutive patients who underwent MBM for treatment
of BE in 14 tertiary referral centers in Europe, the United States, Canada, and Australia
were included. Primary outcomes were perforation and postprocedural bleeding rate.
Potential risk factors were identified by logistic regression.
Results
Between 2001 and 2016, a total of 3827 MBM procedures were performed in 2447 patients
(84% male, mean age 66 years, median BE length C2M4). Perforation occurred in 17 procedures
(0.4%; 95% confidence interval [CI], 0.3-0.7), of which 15 could be treated endoscopically
or conservatively. Female gender was an independent risk factor for perforation (odds
ratio [OR], 2.77; 95% CI, 1.02-7.57; P = .05). Postprocedural bleeding occurred after 35 procedures (0.9%; 95% CI, 0.6-1.3).
The number of resections (OR, 1.15; 95% CI, 1.06-1.25; P < .001) was significantly associated with postprocedural bleeding.
Conclusion
The results of this study show that MBM for BE is safe with a low risk of serious
adverse events. In addition, most of the adverse events could be managed endoscopically
or conservatively. The number of resections was an independent risk factor for postprocedural
bleeding.
Abbreviations:
BE (Barrett’s esophagus), CI (confidence interval), ER (endoscopic resection), IQR (interquartile range), MBM (multiband mucosectomy), OR (odds ratio)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions.Gastrointest Endosc. 1993; 39: 58-62
- Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett’s neoplasia.Gastrointest Endosc. 2011; 74: 35-43
- Safety and efficacy of multiband mucosectomy in 1060 resections in Barrett’s esophagus.Endoscopy. 2011; 43: 177-183
- Trimodal imaging-assisted endoscopic mucosal resection of early Barrett’s neoplasia.Surg Endosc. 2009; 23: 1609-1613
- Endoscopic resection with ligation using a multi-band mucosectomy system in Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma.Ther Adv Gastroenterol. 2009; 2: 323-330
- Multiband mucosectomy for endoscopic resection of Barrett’s esophagus: feasibility study with matched historical controls.Eur J Gastroenterol Hepatol. 2007; 19: 311-315
- Use of modified multiband ligator facilitates circumferential EMR in Barrett’s esophagus (with video).Gastrointest Endosc. 2006; 63: 847-852
- multivariate imputation by chained equations in R.J Stat Softw. 2011; 45: 1-67
- Fully conditional specification in multivariate imputation.J Stat Comput Simul. 2006; 76: 1049-1064
- Development, implementation and evaluation of multiple imputation strategies for the statistical analysis of incomplete data sets. PhD thesis.Erasmus University, Rotterdam1999
- Diagnosis and management of esophageal perforations.Am Surg. 1992; 58: 112-119
- Current results of therapy for esophageal perforation.Am J Surg. 1995; 169: 615-617
- Short- and long-term outcome of esophageal perforation.Gastrointest Endosc. 1995; 41: 130-134
- A prospective multicenter study using a new multiband mucosectomy device for endoscopic resection of early neoplasia in Barrett’s esophagus.Gastrointest Endosc. 2018; 88: 647-654
- Comparison of two multi band mucosectomy devices for endoscopic resection of Barrett’s related neoplasia (PTU-022).Gut. 2017; 66: A61-A62
- Results of a two-phased clinical study evaluating a new multiband mucosectomy device for early Barrett’s neoplasia: a randomized pre-esophagectomy trial and a therapeutic pilot study.Surg Endosc. 2019; 33: 2864-2872
- Risk factors for perforation of endoscopic submucosal dissection in gastric tumors [abstract].Gastrointest Endosc. 2011; 73: AB399
- Clinical outcomes of and management strategy for perforations associated with endoscopic submucosal dissection of an upper gastrointestinal epithelial neoplasm.Surg Endosc. 2016; 30: 5059-5067
- Risk factors for perforation associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type.Surg Endosc. 2012; 26: 2456-2464
- Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma.World J Gastroenterol. 2017; 23: 478-485
- Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissection.Gastrointest Endosc. 2016; 84: 98-108
- Perforation and postoperative bleeding associated with endoscopic submucosal dissection in colorectal tumors: an analysis of 398 lesions treated in saga Japan.Intern Med. 2018; 57: 2115-2122
- Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia: a retrospective nationwide study in Japan.Gastrointest Endosc. 2016; 84: 971-982
- Risk factors for procedure-related complications after endoscopic resection of colorectal laterally spreading tumors.Medicine. 2018; 97: 1-7
- Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors.Surg Endosc. 2015; 29: 133-139
- A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections.Gastrointest Endosc. 2010; 72: 1217-1225
- Predictors of esophageal stricture formation post endoscopic mucosal resection.Clin Endosc. 2014; 47: 155-161
- Predictors of stricture following complete Barrett’s excision by stepwise endoscopic resection in short-segment disease: long term outcomes and predictors of stricture.Endoscopy. 2011; 43: 1025-1032
- Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial.Gut. 2011; 60: 765-773
- Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett’s esophagus: a critical assessment of histologic outcomes and adverse events.Gastrointest Endosc. 2014; 79: 718-731
Article info
Publication history
Published online: March 30, 2020
Accepted:
March 19,
2020
Received:
December 24,
2019
Footnotes
DISCLOSURE: Dr Teshima received research support from Medtronic and Vantage Endoscopy. Dr Wang has consulted for Boston Scientific and undertaken research for Interscope and Fujinon. Dr Wallace has received research grants from Fujifilm, Medtronic, ChiroChem, Olympus, and Boston Scientific, has been a consultant for Ninepoint on behalf of Mayo Clinic and a general consultant for Cosmo Pharmaceuticals. Dr Haidry has undertaken research for Cook Medical, Pentax Europe, Covidien/Medtronic, Beamline Technologies, and C2 Therapeutics. Dr Koch has undertaken research for Cook medical and Interscope and has received speaker and consultancy fees from ErbeElektromedizin. Dr Ragunath has received educational and research grants from Cook Medical, consultancy fees from Olympus, consultancy fees and educational grants from Boston Scientific, and educational and research grants from Pentax. Dr Weusten has received financial support for research and speaker fees from Pentax Medical. Dr Schoon has received speaker and consultancy fees from Medtronic, Boston Scientific, and Olympus, and financial support for research from Fujifilm. Dr Bisschops has received speaker fees from Medtronic, Pentax, and Fujifilm, consultancy fees from Medtronic, Boston Scientific, Pentax, and Fujifilm, and financial support for research from Cook Medical, Medtronic, Pentax, and Fujifilm. Dr Bergman has received financial support for research from Covidien/Medtronic, Olympus Endoscopy, Cook Medical, Boston Scientific, Erbe Medical, C2 Therapeutic, and Ninepoint Medical, and consultancy fees from Boston Scientific, Cook Medical, Covidien/Medtronic. All other authors disclosed no financial relationships.
See CME section; p. 404
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
