TY - JOUR
T1 - Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality
T2 - Endoscopic Findings and Long-Term Mortality
AU - van Munster, S. N.
AU - Nieuwenhuis, E. A.
AU - Weusten, B. L. A. M.
AU - Herrero, L. Alvarez
AU - Bogte, A.
AU - Alkhalaf, A.
AU - Schenk, B. E.
AU - Schoon, E. J.
AU - Curvers, W.
AU - Koch, A. D.
AU - van de Ven, S. E. M.
AU - de Jonge, P. J. F.
AU - Tang, T.
AU - Nagengast, W. B.
AU - Peters, F. T. M.
AU - Westerhof, J.
AU - on behalf of the Dutch Barrett Expert Centers
AU - Houben, M. H. M. G.
AU - Bergman, Jacques J. G. H. M.
AU - Pouw, R. E.
N1 - Publisher Copyright: © 2020, The Author(s).
PY - 2021/1
Y1 - 2021/1
N2 - Introduction: After endoscopic resection (ER) of neoplasia in Barrett’s esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. Methods: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. Results: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11–51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. Conclusion: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.
AB - Introduction: After endoscopic resection (ER) of neoplasia in Barrett’s esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. Methods: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. Results: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11–51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. Conclusion: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.
KW - Barrett’s esophagus
KW - Endoscopic mucosal resection
KW - Endoscopic therapy
KW - Esophageal adenocarcinoma
UR - http://www.scopus.com/inward/record.url?scp=85094907770&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11605-020-04836-8
DO - https://doi.org/10.1007/s11605-020-04836-8
M3 - Article
C2 - 33140322
SN - 1091-255X
VL - 25
SP - 67
EP - 76
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -