Acceptance of Endoscopic Treatment of Patients with Early Barrett's Neoplasia

Abstract

Background: Endoscopic treatment of early neoplastic lesions arising in Barrett's esophagus has gained more and more acceptance in recent years, especially in specialized centers. However, so far there is no valid data about the general acceptance of endoscopic treatment. Objective: To investigate the general acceptance of endoscopic therapy among major gastroenterological departments Design: A direct email survey was sent to all German University Hospitals and large community hospitals. Results: 40 gastroenterological departments were contacted and 27 responded (67.5%). All respondents were utilizing high-resolution video-endoscopy in combination with an advanced imaging technique (e.g. chromoendoscopy, NBI, FICE) and 92.5% EUS for the work up of patients with neoplastic lesions in Barrett's esophagus. 82% of the respondents were performing endoscopic resection (ER) with or without thermal ablative methods (e.g. APC) as the primary endoscopic treatment method. Only 14% were using photodynamic therapy (PDT) in combination with ER. 89% and 96% of the respondents would recommend ER as the treatment of choice to a 50-year old and 80-year old patient with mucosal Barrett's cancer (BC), respectively. However, in case of multifocal mucosal BC in a long segment Barrett's esophagus 73% of the respondents would recommend surgical treatment to a 50-year old patient (11% in case of a 80-year old patient). In case of a cancer invading the upper third of the submucosal layer without lymphatic invasion, 63% would recommend endoscopic treatment. Conclusions: These data suggest that endoscopic treatment, especially ER, is widely accepted as the primary treatment of choice in patients with early Barrett's neoplasia in Europe.