Impact of endoscopic mucosal resection in the histologic reclassification and treatment of Barrett’s esophagus associated dysplasia

Abstract

Introduction and aims. In selected patients, endoscopic mucosal resection (EMR) is a valuable tool for diagnosis and treatment of Barrett's esophagus (BE). Currently, there is few available information regarding the reclassification of histological diagnosis in BE associated focal lesions. The aim was to evaluate the reclassification of histological diagnosis post-EMR, in patients with BE with biopsy proven dysplasia. Material and methods. This is a retrospective and descriptive study. We included patients with BE from January 2002-december 2013, in whom EMR was performed and had a previous biopsy with either low grade dysplasia (LGD), high grade dysplasia (HGD) or intramucosal carcinoma (IMC).EMR was performed by either the cap technique or by using the multi-band ligator technique. Results. We analyzed 41 specimens obtained in 19 EMR procedures performed in 11 patients. When pre and post-EMR diagnosis were evaluated, there was a reclassification in histological diagnosis in 7 of 11 (63%) patients (downstaging occurred in 5 and upstaging occurred in 2 patients). The global follow-up time was 45 (3-95) months. Nine patients (81.8%) received endoscopic eradication therapy without recurrence in the follow up. There were no procedure related complications. Conclusions. EMR conditions a significant change in histological diagnosis in BE with dysplasia patients.