Abstract
Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective treatments for Barrett’s neoplasia. However, little is known about recurrence rates following these techniques. We compared long-term neoplasia recurrence rates following EMR and ESD.
Methods This study included patients with Barrett’s neoplasia (high grade dysplasia/adenocarcinoma) treated between July 2019 and December 2023 at a tertiary referral center in Canada. Outcomes were residual neoplasia at first follow-up, complete remission of neoplasia (CRN), and neoplasia recurrence following CRN.
Results 157 patients were included (87 EMR, 70 ESD). Compared
with EMR, the ESD group had larger lesions (median 2 vs. 3 cm, P <0.05), more adenocarcinoma
(85.1% vs. 94.3%, P = 0.07), and deeper submucosal invasion (T1a: 71.6% vs. 75.8%; T1b-SM1:
25.7% vs. 6.1%; T1b≥SM2: 2.7% vs. 18.2%; P <0.05). Among 124 patients with follow-up (71
EMR, 53 ESD), 84.9% of ESD-treated patients had curative resections (i.e. R0 resection with
low risk for lymph node metastasis), whereas 94.4% of EMR-treated patients had deep margin R0
resection of low risk lesions. At first follow-up, residual neoplasia (14.1% vs. 11.3%) and
CRN (97.2% vs. 100%) were similar in the EMR and ESD groups, but neoplasia recurrence
following CRN was significantly higher with EMR (13% vs. 1.9%, P <0.05), with cumulative
probability of recurrence at 3 years of 18.3% vs. 4.2%, respectively.
Conclusions Neoplasia recurrence following CRN was significantly higher following EMR compared with ESD, suggesting that ESD may be superior to EMR in preventing neoplasia recurrence in Barrett’s esophagus.
