Long-term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma

A. Larghi; C. J. Lightdale; A. S. Ross; P. Fedi; J. Hart; H. Rotterdam; A. Noffsinger; L. Memeo; G. Bhagat; I. Waxman

doi:10.1055/s-2007-966788

Endoscopy 2007; 39(12): 1086-1091
DOI: 10.1055/s-2007-966788

Original article

Long-term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma

A. Larghi¹ , C. J. Lightdale² , A. S. Ross¹ , P. Fedi² , J. Hart³ , H. Rotterdam⁴ , A. Noffsinger³ , L. Memeo⁴ , G. Bhagat⁴ , I. Waxman¹

¹Section of Endoscopy and Therapeutics and the Cancer Research Center, The University of Chicago, Chicago, Illinois, USA
²Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York, USA
³Department of Pathology, The University of Chicago, Chicago, Illinois, USA
⁴Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, USA

Abstract

Background and study aims: In patients with Barrett’s esophagus (BE), targeted endoscopic mucosal resection (EMR) of visible lesions of high grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) is effective, but carries the risk of leaving in place synchronous lesions and Barrett’s epithelium with the potential for recurrent disease. We evaluated the safety and long-term efficacy of complete Barrett’s eradication EMR (CBE-EMR) for the treatment of patients with HGD or IMC, independently of the presence of macroscopically visible lesions or surgical risk.

Patients and methods: 26 consecutive patients with BE and HGD or IMC underwent CBE-EMRs, which were performed with the endoscopic cap suction method and/or a 2.3-mm monofilament mucosectomy snare. Endoscopic follow up after completion of resection was carried out to assess the rate of residual or recurrent BE with or without HGD or IMC.

Results: 24 patients completed the study. They underwent a total of 44 EMR sessions with a median of 3 pieces (range 1-8) removed per session. Two patients with immediate bleeding were successfully managed endoscopically. Three patients developed an early esophageal stricture that was completely resolved with a single endoscopic dilation. After a median follow-up of 28 months (range 15-51 months), persistent endoscopic and histologic eradication of BE was demonstrated in 21 patients (87.5 %). In two patients, Barrett’s epithelium was detected beneath the neosquamous epithelium 3 months after completion of the resection. In the remaining patient, IMC was found in a nodule seen and removed by EMR at 12-month surveillance endoscopy.

Conclusions: CBE-EMR is a safe and highly effective long-term treatment that should be offered to all patients with Barrett’s esophagus with HGD and IMC.

Full Text

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I. Waxman, MD

The University of Chicago, Section of Gastroenterology

5758 S. Maryland Avenue, MC 9028

Chicago

Illinois 60637

USA

Fax: +1-773-834-7209

Email: iwaxman@medicine.bsd.uchicago.edu