Comparing recurrence rates between endoscopic mucosal resection and endoscopic submucosal dissection in Barrett’s endoscopic therapy: patient perspective matters!

We read with interest the editorial by Vantanasiri and Iyer on the recently published study by Fujiyoshi et al. [1] [2]. Achieving complete remission of intestinal metaplasia (CRIM) is a key objective in the management of Barrett’s esophagus (BE). However, to ensure patient-centered outcomes, the journey to achieving this goal matters.

Vantanasiri and Iyer question the clinical relevance of achieving en bloc resection with endoscopic submucosal dissection (ESD) in BE, as its benefits could be reduced with subsequent ablative therapy. In their study, Fujiyoshi et al compared the rates of neoplasia recurrence in BE following endoscopic mucosal resection (EMR) and ESD. They found a higher recurrence rate after complete remission of neoplasia (CRN) in the EMR group, regardless of similar rates of CRN, CRIM, and adverse events in both groups [2]. In a large multicenter study, we previously reported that ESD was safe and had lower rates of recurrence compared with EMR. We also described how patients who had undergone EMR required significantly more endoscopic procedures to treat any remaining/recurrent dysplasia compared with those undergoing ESD [3].

Irrespective of the time of recurrence, the presence of fibrosis renders subsequent attempts at resection of dysplasia difficult and fraught with higher risk for complications. In a recent study, salvage ESD after recurrence of Barrett’s neoplasia following radiofrequency ablation was successful in only 58.9% of cases and complications were reported in 14.3% of cases [4].

The perception of recurrence is very different from the perspective of a patient. For the patient, cancer noted on follow-up pathology could lead to significant distress, additional endoscopic procedures, missed work days, tumor board discussions, and increased healthcare utilization costs. Although eradication of all intestinal metaplasia is suggested as the optimal goal for endoscopic eradication, patients deserve the most definitive therapy upfront.

Publication History

Article published online:
22 April 2025

• References

• 1 Vantanasiri K, Iyer PG. Comparing recurrence rates between endoscopic mucosal resection and endoscopic submucosal dissection in Barrett’s endoscopic therapy: timing and definitions matter!. Endoscopy 2024;
• 2 Fujiyoshi Y, Khalaf K, Tham D. et al. Recurrence following successful eradication of neoplasia with endoscopic mucosal resection compared with endoscopic submucosal dissection in Barrett’s esophagus: a retrospective comparison. Endoscopy 2024;
• 3 Mejia Perez LK, Yang D, Draganov PV. et al. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett’s neoplasia in the West: a retrospective study. Endoscopy 2022; 54: 439-446
• 4 Mesureur L, Deprez PH, Bisschops R. et al. Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation. Endoscopy 2024; 56: 653-662