Barrett's esophagus: The advocacy for ESD

Endoscopic eradication therapy for Barrett’s esophagus–related neoplasia: a final 10-year report from the UK National HALO Radiofrequency Ablation Registry

“…35 Some endoscopists have advocated endoscopic submucosal dissection as routine treatment. 36 This technique is harder to learn than EMR and has a higher risk profile. Our work suggests that EMR with RFA should remain the standard of care, although in specific circumstances operators might want to consider endoscopic submucosal dissection, particularly for patients who develop new lesions after RFA has commenced.…”

Cyclodextrin Polymer Preserves Sirolimus Activity and Local Persistence for Antifibrotic Delivery over the Time Course of Wound Healing

“…3−5 Endoscopic submucosal dissection (ESD) is one such treatment option for early stage esophageal cancers and cases of Barrett's esophagus with high-grade dysplasia. 6,7 ESD is advantageous as complete removal of cancerous tissue can be confirmed via histology of en bloc resected tissue, and the procedure has proven to increase disease-free survival rates. 8−11 However, fibrotic processes accompanying ESD often result in scarring and dysphagic stricture of the esophagus, especially in patients with extensive or circumferential ESD for which post-procedure stricture rates of 70% and higher have been reported.…”

“…Improved survival outcomes correlate with early detection and early treatment. While critical changes in early detection methods are in development, minimally invasive early treatment options still exhibit some drawbacks. − Endoscopic submucosal dissection (ESD) is one such treatment option for early stage esophageal cancers and cases of Barrett’s esophagus with high-grade dysplasia. , ESD is advantageous as complete removal of cancerous tissue can be confirmed via histology of en bloc resected tissue, and the procedure has proven to increase disease-free survival rates. − However, fibrotic processes accompanying ESD often result in scarring and dysphagic stricture of the esophagus, especially in patients with extensive or circumferential ESD for which post-procedure stricture rates of 70% and higher have been reported. − Postsurgical attempts to relieve stricture, such as mechanical balloon dilation, require many procedures due to the refractory nature of the stricture over months to years with risk of perforation, internal bleeding, and reduced patient quality of life. Other strategies include introducing a stent, applying surgical meshes, and steroid therapies, yet none have sufficiently addressed post-ESD stricture to improve patient quality of life. ,− …”

Endoscopic submucosal dissection in endotherapy for Barrett’s esophagus–related dysplasia and neoplasia: An essential or optional technique?

“…Given these encouraging data from large case series such as these and others, 11 recent opinions from experts and endoscopy societies support the use of ESD in larger lesions (>15-20 mm) or those with endoscopic characteristics suggestive of extensive submucosal invasion (such as Paris type IIc or ulcerated lesions) or in the presence of underlying scarring from prior incomplete resection or ablation. 12 In the only randomized trial to compare these 2 approaches, 40 patients with BE HGD or carcinoma were randomized to initial EMR (n Z 20) or ESD (n Z 20). 13 Importantly, patients were randomized only if the lesion was 3 cm or smaller in maximal dimension and less than half the circumference of the esophageal lumen.…”