3514 ENDOSCOPIC MUCOSAL RESECTION OF EARLY CANCER AND HIGH GRADE DYSPLASIA IN BARRETT'S ESOPHAGUS.

Abstract

Introduction: In the view of the mortality and morbidity rate of esophagectomy and the relatively large group of inoperable patients local therapeutic techniques for high grade dysplasias (HGD) and early Barrett's cancer (EC) are required. Patients&Method: From 10/96 to 4/99 in Wiesbaden 96 Pat. with proven HGD and/or EC in Barrett's esophagus were treated by means of a local therapy after carefull staging (Video-endoscopy including chromoendoscopy, if necessary photodynamic diagnostics, biopsies from all visible lesions and quadrant biopsies every 2 cm, conventional endosonography as well as 20MHz-probe, abdominal ultrasound, X-ray of the thorax, CT of the thorax and upper abdomen). In 64/96 patients EMR was performed. These 64 pat. were divided into 2 groups: group A (n=35) fulfilled "low-risk"-criteria: mucosal lesion, diameter up to 20mm; macroscopic type I, IIa, IIb, IIc and histological grading G1-G2 or HGD. The remaining 29 patients were included in group B ("high risk"). Results: Totally, 120 resections were performed without technical problems. The mean number of treatment sessions per patient was 1.3±0.6 in group A and 2.8±2.0 in group B (p<0.0005). Only one major complication in form of a spurting bleeding was seen, which could be managed endoscopically, no perforation occurred. Complete local remission (CLR) was significantly (p=0.008) earlier achieved in group A than group B. Up to now complete remission was achieved in 97% in group A and in 59% in group B, but 1 resp. 9 patients are still under therapy or the first control has to be expected, so the CLR will be probably higher. During the mean follow-up period of 12±8 months recurrent or metachronous carcinomas were seen in 14%. Conclusions: Mucosectomy of Barrett's early carcinomas shows a promising low morbidity and mortality. Mucosectomy might offer a new minimally invasive therapeutic alternative to esophagectomy especially in "low risk" situations. A comparison with surgery remains to be done until long-term results are available.