TY - JOUR
T1 - Extending treatment criteria for Barrett's neoplasia
T2 - Results of a nationwide cohort of 138 endoscopic submucosal dissection procedures
AU - van Munster, Sanne N.
AU - Verheij, Eva P. D.
AU - Nieuwenhuis, Esther A.
AU - Offerhaus, Johan G. J. A.
AU - Meijer, Sybren L.
AU - Brosens, Lodewijk A. A.
AU - Weusten, Bas L. A. M.
AU - Alkhalaf, Alaa
AU - Schenk, Ed B. E.
AU - Schoon, Erik J.
AU - Curvers, Wouter L.
AU - van Tilburg, Laurelle
AU - van de Ven, Steffi E. M.
AU - Tang, Thjon J.
AU - Nagengast, Wouter B.
AU - Houben, Martin H. M. G.
AU - Seldenrijk, Kees C. A.
AU - Bergman, Jacques J. G. H. M.
AU - Koch, Arjun D.
AU - Pouw, Roos E.
N1 - Funding Information: BW received financial support for IRB-approved research from C2Therapeutics/Pentax Medical. JB received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, Med-tronic, and Aqua Medical. The other authors declared no competing interests. Publisher Copyright: © 2022 Georg Thieme Verlag. All rights reserved.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett s esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands. Methods Retrospective assessment of outcomes, using treatment and follow-up data from a joint database. Results 130/138 patients had complete ESDs, with 126/ 130 (97%) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90 180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52%; 19% sm1, 33%≤sm2). Among resections of HGD or T1a EAC lesions, 87% (95%CI 75% 92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49% (36% 60 %). Among R1 resections, 10/34 (29%) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %. Conclusion In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50%, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.
AB - Background The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett s esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands. Methods Retrospective assessment of outcomes, using treatment and follow-up data from a joint database. Results 130/138 patients had complete ESDs, with 126/ 130 (97%) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90 180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52%; 19% sm1, 33%≤sm2). Among resections of HGD or T1a EAC lesions, 87% (95%CI 75% 92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49% (36% 60 %). Among R1 resections, 10/34 (29%) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %. Conclusion In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50%, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.
UR - http://www.scopus.com/inward/record.url?scp=85130904321&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1658-7554
DO - https://doi.org/10.1055/a-1658-7554
M3 - Article
C2 - 34592769
SN - 0013-726X
VL - 54
SP - 531
EP - 541
JO - Endoscopy
JF - Endoscopy
IS - 6
ER -