Endoscopic mucosal resection for Barrett’s esophagus-related neoplasia

Abstract

Evaluation of: Lopes CV, Hela M, Pesenti C et al. Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg. Endosc. 21(5), 820–824 (2007).High-grade dysplasia may progress to esophageal adenocarcinoma in 16–32% of patients. Esophagectomy is the definitive therapy; however, the procedure has a mortality rate of 3–12% and 29–56% of patients develop at least one serious postoperative complication. Endoscopic mucosal resection (EMR) for high-grade dysplasia or early carcinoma has been proposed for selected patients. With conventional EMR, Barrett’s epithelium is left behind, invasive lesions may be missed due to sampling error and long-term outcomes remain unknown. A recent study reports a mean follow-up of 31.6 months in patients treated with circumferential EMR. Allowing multiple sessions of EMR and repeat EMR for recurrence, the study reports a 90% success rate. EMR changed the initial biopsy diagnosis in 34% of patients. Another trial of EMR recently described the long-term follow-up of patients with early Barrett’s-associated cancer who were managed with EMR. Complete local remission was achieved in 99% of patients. The 5-year survival rate was 98%. EMR should be a part of the evaluation of Barrett’s-associated neoplasia. As mucosal resection evolves, the technique may become standard management for highly selected subgroups of patients.