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Endoscopy 2008; 40(12): 1016-1020
DOI: 10.1055/s-0028-1103401
Total Barrett Eradication review section

© Georg Thieme Verlag KG Stuttgart · New York

Total endoscopic resection of Barrett esophagus

S.  Seewald1 , T.  L.  Ang2 , T.  Gotoda3 , N.  Soehendra4
  • 1Center of Gastroenterology , Klinik Hirslanden, Zurich, Switzerland
  • 2Division of Gastroenterology, Changi General Hospital, Singapore
  • 3Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  • 4Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Publication History

Publication Date:
08 December 2008 (online)

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Introduction

Barrett’s esophagus with high grade intraepithelial neoplasia (HGIN) is associated with disease progression of greater than 10 % per year [1]. In the context of intramucosal cancer (IMC) without deep submucosal involvement, there is no risk of distant metastasis. Endoscopic mucosal resection (EMR) is a feasible lower risk alternative to surgery for HGIN and IMC. The indications for EMR are HGIN and well or moderately differentiated IMC [2] [3].

Total endoscopic resection (TER) of all Barrett’s mucosa has the advantage over localized resection in that it removes all at-risk mucosa, thus reducing the risk of recurrent disease compared with localized resection [4] [5]. Peters et al. studied the properties of the neosquamous epithelium that regenerates after TER of Barrett’s esophagus. They used immunohistochemical staining for the proliferation marker Ki67 and p53 protein accumulation as well as fluorescent in situ hybridization for numerical chromosomal abnormalities and specific losses of tumor suppressor genes p16 and p53. Whereas all patients had multiple abnormalities in their Barrett’s esophagus prior to TER, none were found in their neosquamous epithelium after TER. This suggests that TER may indeed provide a permanent cure for early neoplasia in Barrett’s esophagus [6].

Most groups that have reported on TER have used piecemeal resection for removal of the Barrett’s esophagus. Endoscopic submucosal dissection (ESD), originally introduced for early gastric cancer [7], has been attempted in the context of intramucosal Barrett’s cancer to achieve en bloc resection [8] [9] [10] but the experience with ESD for TER is limited as yet.

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S. SeewaldMD 

GastroZentrumKlinik Hirslanden

Witellikerstrasse 40
8008 Zürich
Switzerland

Fax: +41-44-3873966

Email: stefan.seewald@gastrozentrum.ch