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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2007

01-05-2007

Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma

Authors: C. V. Lopes, M. Hela, C. Pesenti, E. Bories, F. Caillol, G. Monges, M. Giovannini

Published in: Surgical Endoscopy | Issue 5/2007

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Abstract

Background

Barrett’s esophagus–related high-grade dysplasia or mucosal cancer can be treated by endoscopic mucosal resection (EMR), but the adjacent metaplastic epithelium remains at risk for developing further lesions. Our objective was to evaluate the results of the circumferential EMR in removing not only the neoplastic lesion but also the remaining Barrett’s epithelium.

Methods

Forty-one consecutive patients (mean age: 66 years) with Barrett’s esophagus were submitted to 63 EMR sessions in one single-referral endoscopic unit. All patients had high-grade dysplasia, and cancer was detected in 23 of these cases, most of them classified as T1N0 (20 patients) by endosonography. Mucosectomy after saline submucosal injection was performed for the neoplastic lesions and, if necessary, the residual Barrett’s epithelium was removed by the same technique one month later.

Results

A retrospective evaluation showed that, during a mean follow-up of 31.6 months, Barrett’s epithelium was completely replaced by squamous epithelium in 31 (75.6%) cases. There were 10 complications, all of which were managed endoscopically: 8 cases of bleeding and two perforations occurred in 9 (14.3%) patients. One patient developed an esophageal stricture. Barrett’s epithelium recurred in 10 (24.4%) patients and recurrent or metachronous early cancer was detected in 5 (12.2%), all but one of which were treated again by EMR; the fifth patient was referred to surgery. Argon plasma coagulation was used in 6 cases to treat Barrett’s epithelium, and two patients received concomitant chemoradiotherapy as adjuvant therapy.

Conclusions

Circumferential EMR provides an effective endoscopic approach to the management of Barrett’s esophagus-related high-grade dysplasia and mucosal cancer. Additional studies are necessary to evaluate the long-term results.
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Metadata
Title
Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma
Authors
C. V. Lopes
M. Hela
C. Pesenti
E. Bories
F. Caillol
G. Monges
M. Giovannini
Publication date
01-05-2007
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 5/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9187-3

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