Endoscopic Submucosal Dissection for Barrett’S Related Neoplasia in the Netherlands: Results of a Nationwide Cohort of 130 Cases

Aims The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett’s esophagus (BE). We aimed to report the outcomes of all ESDs for BE neoplasia performed in expert centers in the Netherlands.

Methods Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 9 expert centers with specifically and jointly trained endoscopists and pathologists, and treatment/FU data collected in a joint database. ESD is restricted to 5 centers and is restricted for large and bulky lesions that cannot be removed with cap-based ER and/or with suspicion for submucosal invasion. We report efficacy and safety outcomes of all successfully completed ESD BE cases in the Netherlands since 2008. En-bloc resection was defined as complete resection of the delineated target lesion in a single piece, R0-resection as absence of cancer in the vertical/lateral margin.

Results 130 ESDs were performed and during median 121 minutes (IQR 90-180), 97 % (126/130) were removed en-bloc. Lesion diameter was median 30mm (IQR10-40) over 30 % of the circumference (25-50). Pathology was T1a-EAC(48 %) or T1b-EAC (52 %; 19 %sm1 and 33 %≥sm2). The combined en-bloc and R0 resection rate was 87 % [95 %-CI 77-94] for T1a-EAC, and 49 % [95 %-CI 37-62] for T1b-EAC. Upon R1 resection, 29 %(10/34) had residual cancer, in all cases detected at first FU endoscopy, while the remaining 71 %(24/34) had no residual cancer in esophagectomy specimen (n = 4) or during median endoscopic FU of 9 months(4-22) (n = 20). Upon R0 resection, the local recurrence rate during median 17 months FU(IQR 8-30) was 0 %[95 %-CI 0-5]. Adverse events: 1 % perforation [95 %-CI 0-4], 3 % post-procedural bleeding [95 %-CI 1-7] and 13 % strictures [95 %CI 8-20], resolved with median 3(IQR1-12) dilatations.

Conclusions In expert hands, ESD is safe and allows removal of (submucosal) EAC. R1 resection does not necessarily imply residual cancer, and endoscopic restaging may help in identifying patients who do have residual cancer.

Citation: Verheij EPD, van Munster SN, Nieuwenhuis EA et al. OP25 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR BARRETT’S RELATED NEOPLASIA IN THE NETHERLANDS: RESULTS OF A NATIONWIDE COHORT OF 130 CASES. Endoscopy 2021; 53: S14.

Publication History

Article published online:
19 March 2021