Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: an Italian experience

To evaluate endoscopic mucosal resection (EMR) in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE). Between June 2000 and December 2003, 39 consecutive patients with HGD (35) and/or IMC (4) underwent EMR. BE >30 mm was present in 27 patien...

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Published in:World journal of gastroenterology : WJG 2005-11, Vol.11 (42), p.6650-6655
Main Authors: Conio, Massimo, Repici, Alessandro, Cestari, Renzo, Blanchi, Sabrina, Lapertosa, Gabriella, Missale, Guido, Della Casa, Domenico, Villanacci, Vincenzo, Calandri, Pier Gigi, Filiberti, Rosangela
Format: Article
Language:English
Subjects:
Aged
Barrett Esophagus - pathology
Barrett Esophagus - surgery
Brief Reports
Endoscopy, Gastrointestinal
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagus - anatomy & histology
Esophagus - pathology
Female
Humans
Italy
Male
Middle Aged
Precancerous Conditions
Retrospective Studies
Treatment Outcome
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Summary:To evaluate endoscopic mucosal resection (EMR) in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE). Between June 2000 and December 2003, 39 consecutive patients with HGD (35) and/or IMC (4) underwent EMR. BE >30 mm was present in 27 patients. In three patients with short segment BE (25.0%), HGD was detected in a normal appearing BE. Lesions had a mean diameter of 14.8+/-10.3 mm. Mucosal resection was carried out using the cap method. The average size of resections was 19.7+/-9.4 x 14.6+/-8.2 mm. Histopathologic assessment post-resection revealed 5 low-grade dysplasia (LGD) (12.8%), 27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%). EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwent surgery. Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy, occurred in four patients (10.3%). After a median follow-up of 34.9 mo, all patients remained in remission. In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v11.i42.6650