S0361 Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for the Treatment of Dysplastic Barrett's Esophagus and Adenocarcinoma

Abstract

INTRODUCTION: Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions are commonly treated with endoscopic mucosal resection (EMR). However, EMR may be associated with incomplete resection resulting in local recurrence. Endoscopic submucosal dissection (ESD) has been recognized as an alternative treatment with durable results and lower risk of recurrence. The aim of this study is to evaluate the comparative effectiveness of EMR to ESD for Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions. METHODS: This was a single-center retrospective study of adult patients that underwent EMR and ESD for the treatment of dysplastic Barrett’s esophagus and non-invasive adenocarcinoma from 2015 to 2019. Baseline data was collected for age, gender, size of lesion, prior EMR, procedure times, and pathology. Cases with invasive cancers were excluded. Primary outcomes were en-bloc resection and margin negative (R0) rates. Secondary outcomes were procedure related adverse events (AEs), stricture formation, and recurrence rates. Statistical analyses were performed using Student’s t-test or Fisher’s exact test. A multivariable logistic regression was performed controlling for age, EMR or ESD, lesion size, and prior EMR to determine predictors for stricture formation. RESULTS: A total of 16 patients underwent ESD, 33 patients underwent EMR. Baseline patient, lesion, procedure characteristics and outcomes are summarized in Table 1. Mean size of lesions was larger for patients that underwent ESD compared to EMR (42.50 ± 18.26 vs 10.42 ± 6.57 mm; P < 0.001) with no difference in prior EMR attempts (P = 0.141). En bloc resection was achieved in 100% of ESD and 87.9% of EMR cases (P = 0.152) with higher R0 rate for ESD (100.00% vs 57.58%; P = 0.002). Procedure time was significantly shorter for EMR (46.32 ± 13.74 vs 83.94 ± 27.46 min; P < 0.001). Procedure-related AEs were similar between ESD and EMR (12.50%% vs 3.03%, P = 0.203); esophageal stricture was more common after ESD (P = 0.039). Curative resection rate was higher for ESD (100.00% vs 66.67%, P = 0.008) while local recurrence was more common after EMR (45.45% vs 0.00%; P < 0.001). On multivariable logistic regression, ESD was not a significant predictor of stricture formation after controlling for confounders. CONCLUSION: ESD is associated with a higher rate of complete resection and a lower rate of local recurrence compared to EMR in patients with Barrett’s associated non-invasive adenocarcinoma and dysplastic lesions even when controlling for lesion size.Table 1.: Patient Characteristics and Procedure-Related Outcomes