Background Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for Barrett’s esophagus (BE)-associated high grade dysplasia (BE-HGD) and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking. Aims The authors’ aim was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years. Methods In this single-center, retrospective study drawn from a prospective database, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for 3 to 5 years. Patients with intramucosal adenocarcinoma completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia (CE-D), and intestinal metaplasia (CE-IM), incidence rates (IR), durability of response, location of recurrent IM and dysplasia, and rate of disease progression. Results 50 and 40 patients were included in 3-year and 5-year analyses. Initial CE-HGD, CD-D, and CE-IM were achieved in 98%, 90%, and 60%, respectively. Overall CE-HGD, CE-D, and CE-IM at 3 years were 96% (48/50), 94% (47/50), and 82% (41/50), and at 5 years were 93% (37/40), 88% (35/40), and 75% (30/40). IRs of recurrent IM, dysplasia, and HGD/esophageal adenocarcinoma per person-year of follow-up after initial CE-IM were 12.2%, 4.0%, and 1.4% per person-year for the 5-year cohort. Most recurrences were found immediately below the neosquamocolumnar junction. Two of 7 HGD recurrences occurred later than 4 years after initial eradication, and 2 patients (4%) progressed to adenocarcinoma despite treatment. Conclusion In patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia was successfully treated in most cases. Long-term surveillance is necessary to detect late recurrence of dysplasia.

ABSTR AC TBackground and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America.Methods This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre-and post-ESD histology, and factors associated with failed resection. ResultsIn total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8-88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4-81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19-76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fi-R0 resection, n (%) 128 (74.9 %) R1 resection, n (%) 20 (11.7 %) Rx resection, n (%) 23 (13.5 %) Overall curative resection, n (%) 125 (73.1 %) Curative resection for superficial invasive adenocarcinoma (n = 11) , n (%) 9 (81.8 %) Adverse events, n (%) ▪ Bleeding 4 (2.3 %) ▪ Perforation 7 (4.1 %) ▪ Nausea/abdominal pain 3 (2.9 %) ▪ Postoperative urinary retention 3 (1.8 %)▪ Post-ESD anal stricture 1 (0.6 %) EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.

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Brunner’s gland adenoma is a rare, benign, small-bowel neoplasm. In a few reported cases, it can cause gastrointestinal hemorrhage and can be associated with cellular atypia. We report an 84-year-old woman with a 12-mm Brunner’s gland adenoma in the second part of the duodenum that was successfully removed with a saline injection-lift technique using a hot snare, followed by placement of clips to prevent postpolypectomy bleeding. Pathological examination revealed Brunner’s gland adenoma with high-grade dysplasia and oncocytic features with negative resection margins. The patient recovered uneventfully. Brunner’s gland adenoma is traditionally considered a benign lesion, and few cases in the published literature have reported Brunner’s gland adenoma with dysplasia or neoplasia. This suggests a dysplastic stage in the natural history of Brunner’s gland adenoma and questions the malignant potential of such lesions.