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Endoscopy 2022; 54(05): 439-446
DOI: 10.1055/a-1541-7659
Original article

Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study

Lady Katherine Mejia Perez 
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Dennis Yang
2   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Peter V. Draganov
2   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Salmaan Jawaid
3   Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
,
Amitabh Chak
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
John Dumot
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
Omar Alaber 
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
John J. Vargo
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Sunguk Jang
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Neal Mehta
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Norio Fukami 
5   Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
,
Tiffany Chua
5   Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
,
Moamen Gabr
6   Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
,
Praneeth Kudaravalli
6   Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
,
Hiroyuki Aihara
7   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
Fauze Maluf-Filho 
8   Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
,
Saowanee Ngamruengphong
9   Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Milad Pourmousavi Khoshknab
9   Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Amit Bhatt 
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract

Background The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia.

Methods We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan–Meier curve was used to compare the groups.

Results 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75–30) and 8 (2–18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001).

Conclusions ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.

Figs. 1 s, 2 s, Tables 1 s, 2 s



Publication History

Received: 19 November 2020

Accepted after revision: 14 June 2021

Article published online:
27 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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