Tu1566 Efficacy of Endoscopic Mucosal Resection (EMR) in Eradication of Barrett's Esophagus Related Neoplasia: a Meta-Analysis and Systematic Review

Abstract

Tu1566 Efficacy of Endoscopic Mucosal Resection (EMR) in Eradication of Barrett’s Esophagus Related Neoplasia: a Meta-Analysis and Systematic Review Madhav Desai*, Neil Gupta, Prashanth Vennalaganti, Ajay Bansal, Abhishek Choudhary, Mohammad A. Titi, Cesare Hassan, Prateek Sharma, Alessandro Repici Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, KS; Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL; Gastroenterology and hepatology, Veteran Affairs Medical Center, Kansas City, Kansas City, MO; Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy; Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy Background: Complete endoscopic mucosal resection [EMR] is an established approach for complete eradication of Barrett’s esophagus [BE] related neoplasia: high-grade dysplasia [HGD] and early adenocarcinoma [EAC]. However, efficacy rates in a large cohort of BE patients undergoing EMR as the primary eradication modality are not known. Methods: Two investigators independently identified potentially relevant studies through a search of MEDLINE and ISI Web of Knowledge (1980-2014), Cochrane Central Register of Controlled Trials, clinicaltrials.gov and bibliographic review of secondary sources. Search terms were: “Barrett’s e/oesophagus”, “Endoscopic mucosal resection” (EMR), “endoscopic resection”, dysplasia, adenocarcinoma. Inclusion criteria were: complete or step wise EMR, human studies, patient age 18 years or greater, prospective and retrospective studies, high grade dysplasia [HGD], superficial esophageal adenocarcinoma, sample size of 10 patients or greater and follow up of greater than 1 year. Exclusion criteria were: case reports, conference or symposium abstracts, abstract form only, review articles, Non English language articles, editorials, letters to editors, studies without biopsy proven BE, studies not reporting either efficacy or recurrence, duplicate reports of study samples. Primary outcome was complete eradication of neoplasia [CE-N (HGD/ EAC)]. Secondary outcomes were: 1) Complete eradication of intestinal metaplasia (CE-IM), 2) adverse events and 3) recurrence rates of -EAC, D and IM. Results: The initial composite search identified 22 studies; 10 studies met all the criteria and were included in the final analysis. This included a total of 620 patients, 83% males with a mean age of 66 years. The average follow up duration was 25.6 months [range 15 to 40.6 months]. Sustained CE-N was achieved in 95.7% [530/554] of the patients with CE-IM in 78% [397/508]. The major adverse events reported were: perforation 1.8% (11/620), symptomatic strictures 36.5% (226/620) and significant bleeding 8.2% (51/ 620). The estimated recurrence was: EAC 1.7% (10/574), Dysplasia 3.9% (22/565) and IM 14.3% (75/524). No deaths related to the procedure were reported. Conclusion: EMR, as the primary therapy for eradication of BE related neoplasia, appears to be a highly effective strategy. However, recurrence of intestinal metaplasia and neoplasia occurs in approximately 20% of the treated patients after initial successful eradication. Strictures related to therapy are reported in up to a 1/3 of the patients.