ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR EARLY BARRETT'S NEOPLASIA – IS AGE A BARRIER?

Aims:

ESD is an established therapeutic option for early neoplasia, however it is thought to carry a higher complication rate. The aim of our study was to evaluate the safety and efficacy of ESD for Barrett's neoplasia in an ageing Western population.

Methods:

A retrospective analysis of all ESDs performed for Barrett's neoplasia within a single tertiary referral centre in the UK from 2012 – 2018. Older patients were defined as ≥75 years of age and younger patients < 75 years of age at time of procedure.

Results:

145 of 286 Barrett's resections were ESDs, of which 50 were ≥75 years and 95 < 75 years. Overall age range was 41 – 94 and mean follow up was 3 years. Lesion characteristics were similar, except increased scarring in ≥75 group. R0 resection rate was 68% in ≥75 group and 75% in < 75 group, with only 6.8% of ≥75 group and 4.9% of < 75 group proceeding to surgery or chemoradiotherapy for residual or recurrent neoplasia. Complications occurred in 6.0% of ≥75 group (1 perforation, 2 bleeds) and 4.2% of < 75 group (4 strictures), all of which were endoscopically managed. 4.5% of ≥75 group and 18.5% of < 75 group proceeded to surgery following poor prognostic histology and overall 74% of all patients continued with sole endoscopic management.

Tab. 1:

Lesion characteristics of the 145 ESDs

Age group	Mean age (years)	Mean lesion size (mm)	En-bloc resection n (%)	Previous resection (scarring) n (%)
≥75	82	34.2	47 (94)	15 (30)
< 75	64	31.2	91 (96)	17 (18)
Total	72	32.8	138 (95)	32 (22)

Conclusions:

ESD is safe and effective in all ages. No significant difference was seen in complication rates between age groups and all adverse events were endoscopically treatable with no long term sequelae. We feel that age should not be a barrier to the use of ESD for Barrett's neoplasia.