Endoscopic mucosal resection for Barrett’s esophagus-related neoplasia

Abstract

Evaluation of: Lopes CV, Hela M, Pesenti C et al. Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg. Endosc. 21(5), 820–824 (2007).

High-grade dysplasia may progress to esophageal adenocarcinoma in 16–32% of patients. Esophagectomy is the definitive therapy; however, the procedure has a mortality rate of 3–12% and 29–56% of patients develop at least one serious postoperative complication. Endoscopic mucosal resection (EMR) for high-grade dysplasia or early carcinoma has been proposed for selected patients. With conventional EMR, Barrett’s epithelium is left behind, invasive lesions may be missed due to sampling error and long-term outcomes remain unknown. A recent study reports a mean follow-up of 31.6 months in patients treated with circumferential EMR. Allowing multiple sessions of EMR and repeat EMR for recurrence, the study reports a 90% success rate. EMR changed the initial biopsy diagnosis in 34% of patients. Another trial of EMR recently described the long-term follow-up of patients with early Barrett’s-associated cancer who were managed with EMR. Complete local remission was achieved in 99% of patients. The 5-year survival rate was 98%. EMR should be a part of the evaluation of Barrett’s-associated neoplasia. As mucosal resection evolves, the technique may become standard management for highly selected subgroups of patients.

Keywords::

• adenocarcinoma
• Barrett’s esophagus
• endosonography
• esophageal neoplasms
• esophagectomy
• esophagoscopy
• gastrointestinal endoscopy
• mucous membrane

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.