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Extending the Treatment Criteria for Barrett's Neoplasia
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- This retrospective cohort study reports the outcomes of endoscopic submucosal dissection (ESD) performed in 138 patients with Barrett's neoplasia. Complete ESD was performed in 130 (94%) patients and en bloc resection was achieved in 126 (97%) patients. R1 resection was seen at higher rates with submucosal esophageal adenocarcinoma (EAC; 50%) than with mucosal EAC or high-grade dysplasia lesions (8%). However, residual cancer was only noted in 29% of the patients with R1 resections at the first follow-up endoscopy.
- These results demonstrate that additional tools are needed to help prognosticate which patients with Barrett's neoplasia who undergo ESD with R1 resection will have residual cancer.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
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 in the Netherlands.
METHODS
Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.
RESULTS
130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90-180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %-92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %-60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.
CONCLUSION
In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.
Additional Info
Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures
Endoscopy 2022 Jun 01;54(6)531-541, SN van Munster, EPD Verheij, EA Nieuwenhuis, JGJA Offerhaus, SL Meijer, LAA Brosens, BLAM Weusten, A Alkhalaf, EBE Schenk, EJ Schoon, WL Curvers, L van Tilburg, SEM van de Ven, TJ Tang, WB Nagengast, MHMG Houben, KCA Seldenrijk, JJGHM Bergman, AD Koch, RE PouwFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.