POST ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) STRICTURES - IS RISK RELATED TO PATHOLOGY? A EUROPEAN COMPARISON OF BARRETT’S VERSUS SQUAMOUS NEOPLASIA

Aims ESD is a minimally invasive therapeutic option for early oesophageal neoplasia, however is not without risk. In Europe, the complication profile is most established for Barrett’s neoplasia, being the predominant pathology, and stricture risk has been shown to be related to lesion circumference. Our aim was to compare the safety of ESD between Barrett’s and squamous neoplasia in a Western population.

Methods This was a retrospective analysis of all oesophageal ESDs performed within 3 tertiary referral centres in Europe. The primary outcome was post procedure stricture rate.

Results 226 oesophageal ESDs from 201 patients were included, consisting of 167 Barrett's and 59 squamous neoplasia. Average age was 70.7 in Barrett's and 68.5 in squamous neoplasia, with lesion size 34.6mm and 34.2mm and en bloc resection rate 96.6 and 94.6% respectively. The complication rate was 3/167 perforations or delayed bleeds and 7/167 strictures in Barrett's, with 1/58 perforations or delayed bleeds in squamous and 15/58 strictures in Barrett's (1 patient lost to follow up). Circumferential lesion involvement did increase stricture risk, but did not account for the difference between the two groups (table 1).

Tab. 1 Stricture Risk Stratified by Circumferential Lesion Involvement

Lesion circumference %	Strictures in Barrett´s ESD (n, %)	Strictures in Squamous ESD (n, %)	p-value
≤1/3	0/98 (0.0%)	3/23 (13.0%)	<0.001
>1/3-2/3	1/56 (1.8%)	6/26 (23.1%)	0.001
>2/3	6/13 (46.2%)	6/9 (66.7%)	0.354

Conclusions ESD remains a low risk therapeutic option for early oesophageal neoplasia, however the stricture risk is higher in squamous neoplasia, irrespective of circumferential lesion involvement. We would suggest counselling patients with squamous neoplasia for a higher risk of stricture and having a lower threshold for steroid injection or prophylactic dilatation in these patients.