Efficacy and Safety of Endoscopic Mucosal Resection for Esophageal Lesions in a Private Community Practice Setting

Abstract

Introduction: Endoscopic mucosal resection (EMR) can be performed for a variety of esophageal lesions. EMR offers an effective, safe and minimally invasive alternative to the conventional surgical approach and in conjunction with radiofrequency ablation (RFA), has virtually eliminated esophagectomy for patients with dysplastic Barrett's and intra-mucosal cancer (IMC). However, in a community hospital setting endoscopists mostly had avoided it due to fear of complications, especially perforation. The aim of this study is to review our results of EMR for esophageal lesions with respect to efficacy and safety to better define its utility in a private community practice setting. Methods: This is a retrospective analysis of patients who underwent esophageal EMR between Jan 1st 2014 and July 31st 2016 at our center. Patient's demographics, procedural details, complications and histopathology were analyzed and reported. Results: A total of 115 patients underwent 140 EMR procedures (Tables 1 and 2). The mean age was 66.5 ± 11.9 years and 77% were males. The majority of the EMR were performed in the setting of nodular Barrett's with or without dysplasia (48.6%) and adenocarcinoma (29.3%). EMR was applied to a variety of other mucosal lesions in the esophagus as well. Multiband mucosectomy (MBM) was utilized in the majority of procedures (94.3%). In patients with Barrett's esophagus, EMR in combination with ablation was able to eradicate dysplasia or IMC in 28/32 patients (87.5%). Intra-procedural bleeding occurred in 42 cases (30%), but immediate hemostasis was achieved in all and in majority with the tip of the snare with soft coagulation current. Two patients (1.74%) developed delayed bleeding and one required endoscopy to control bleeding successfully. Four patients (3.7%) with more than 75% circumferential resections, developed strictures, two of them required dilation. There was no case of perforation. Mean operative time was 34.5 ± 14.6 minutes.Table: Table. Summary of Patients' DemographicTable: Table. Histopathological Characteristics of Lesions and Procedure DetailsConclusion: Our results are comparable to previous studies investigating the eradication of Barrett's esophagus with dysplasia and rate of stricture development. Our data shows that EMR is safe and effective diagnostic and therapeutic tool for advanced Barrett's, early esophageal cancer and a variety of other esophageal lesions.Figure: The schematic shows the basic steps of Endoscopic Mucosal Resection.Figure: The images shows different steps involved in Endoscopic Mucosal Resection of the esophageal nodules.