Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation

Lauriane Mesureur; Pierre H. Deprez; Raf Bisschops; Roos E. Pouw; Bas L.A.M. Weusten; Maximilien Barret; Pieter Dewint; David Tate; Philippe Leclercq; Stefan Seewald; Federico Barbaro; Francisco Baldaque-Silva; Masami Omae; Mathieu Pioche; Mariana Figueiredo Ferreira; Michael J. Bourke; Rehan Haidry; Christophe Snauwaert; Pierre Eisendrath; Viviane De Maertelaer; Nicolas Rosewick; Jacques Devière; Arnaud Lemmers

doi:10.1055/a-2307-6949

Endoscopy, Table of Contents

Endoscopy
DOI: 10.1055/a-2307-6949

Original article

Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation

Lauriane Mesureur

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

,

Pierre H. Deprez

²Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

,

Raf Bisschops

³Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Leuven, Leuven, Belgium

,

Roos E. Pouw

⁴Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, Netherlands

,

Bas L.A.M. Weusten

⁵Department of Gastroenterology and Hepatology, St Antonius hospital, Nieuwegein, Netherlands

⁶Department of Gastroenterology and Hepatology, UMC Utrecht, Utrecht University, Utrecht, Netherlands

,

Maximilien Barret

⁷Department of Gastroenterology, Cochin University Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France

,

Pieter Dewint

⁸Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, AZ Maria-Middelares, Ghent, Belgium

,

David Tate

⁹Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium

,

Philippe Leclercq

¹⁰Department of Gastroenterology, Clinique CHC MontLégia, Liège, Belgium

,

Stefan Seewald

¹¹Gastroenterology Center, Klinik Hirslanden, Zurich, Switzerland

,

Federico Barbaro

¹²Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy

,

Francisco Baldaque-Silva

¹³Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

,

Masami Omae

¹³Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

,

Mathieu Pioche

¹⁴Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Mariana Figueiredo Ferreira

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

,

Michael J. Bourke

¹⁵Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

,

Rehan Haidry

¹⁶Department of Gastroenterology, University College London Hospital (UCLH), London, United Kingdom of Great Britain and Northern Ireland

,

Christophe Snauwaert

¹⁷Department of Hepatology and Gastroenterology, Sint-Jan Hospital, Bruges, Belgium

,

Pierre Eisendrath

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

,

Viviane De Maertelaer

¹⁸Institute of Interdisciplinary Research (IRIBHM), Statistical Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium

,

Nicolas Rosewick

¹⁹Laboratory of Experimental Gastroenterology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libre de Bruxelles (ULB), Brussels, Belgium

,

Jacques Devière

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

,

Arnaud Lemmers

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

› Author Affiliations

Abstract

Background This study evaluated the safety and efficacy of salvage endoscopic submucosal dissection (ESD) for Barrett’s neoplasia recurrence after radiofrequency ablation (RFA).

Methods Data from patients at 16 centers were collected for a multicenter retrospective study. Patients who underwent at least one RFA treatment for Barrett’s esophagus and thereafter underwent further esophageal ESD for neoplasia recurrence were included.

Results Data from 56 patients who underwent salvage ESD between April 2014 and November 2022 were collected. Immediate complications included one muscular tear (1.8%) treated with stent (Agree classification: grade IIIa). Two transmural perforations (3.6%; treated with clips) and five muscular tears (8.9%; two treated with clips) had no clinical impact and were not considered as adverse events. Seven patients (12.5%) developed strictures (grade IIIa), which were treated with balloon dilation. Histological analysis showed 36 adenocarcinoma, 17 high grade dysplasia, and 3 low grade dysplasia. En bloc and R0 resection rates were 89.3% and 66.1%, respectively. Resections were curative in 33 patients (58.9%), and noncurative in 22 patients (39.3%), including 11 “local risk” (19.6%) and 11 “high risk” (19.6%) resections. At the end of follow-up with a median time of 14 (0–75) months after salvage ESD, and with further endoscopic treatment if necessary (RFA, argon plasma coagulation, endoscopic mucosal resection, ESD), neoplasia remission ratio was 37/53 (69.8%) and the median remission time was 13 (1–75) months.

Conclusion In expert hands, salvage ESD was a safe and effective treatment for recurrence of Barrett’s neoplasia after RFA treatment.

Full Text

References

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Supplementary Material

Supplementary Material