ENDOSCOPIC RESECTION OF LOW GRADE DYSPLASIA IN BARRETT’S OESOPHAGUS: A RETROSPECTIVE STUDY ABOUT 61 PATIENTS

Aims Barrett Oesohagus (BO) is a pre-cancerous lesion. ESGE recommends LGD endoscopic treatment. Because of the low rate of stenosis with thermablation, ESGE recommends radiofrequency for LGD in BO. However, pre-operative biopsy for BO are nor reliable. That´s why the policy of our unit is to perform endoscopic resection (ER) of LGD, allowing definitive histology on resection piece. We evaluated in this study this management, comparing pre-operative biopsy and final resection, and evaluating complication rate of ER.

Methods Single centre retrospective study based on the extracted data from coding database computer from 2008 to 2018. Endoscopic procedure: ER with cap-assisted technique (Duette system️) after infection of physiologic serum with indigo carmin. Inclusion criteria: LGD with BO referred for ER, with pathological readings by 2 digestive pathologists.

Results 61 (mean age = 58 years old; 41 men) patients were included. 20 patients had a BO < 3 cm, 8 a BO > 6 cm (mean = C1.8;M2.9). All patients underwent a mean of 1.3 ER. No immediate complication with re-intervention was reported. Post operative stenosis was reported for 4 patients (6%). All of them could be managed with endoscopic dilation (max = 3 sessions), and all of them were reported for long Barrett (C > 5 or M > 5).Pre-operative and post-operative histologic correlation was correct for 36 patients (60%). Post operative histology was inflammation for 9 (15%) patients, BO without dysplasia for 14 (22%) patients, adenocarcinoma in situ for 2 patients.Clinical success defined by the absence of LGD at one year, was 85%. No LGD or worst was reported at one year for 52 patients (85%). Mean follow-up was 48 months (12-132). Relapse for LGD was reported for 9 patients (15%)

Conclusions ER for LGD in BO is safe with a low rate of stenosis likely thermablation in particular for BO < 5 cm. ER should allow to adapt follow-up of patients regarding final histology obtained.