Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia

Chevaux, Jean Baptiste; Piessevaux, Hubert; Jouret‐Mourin, Anne; Yeung, Raymond W.; Danse, Étienne; Deprez, Pierre Henri

doi:10.1055/s-0034-1390982

Cited by 83 publications

(104 citation statements)

References 39 publications

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“…Endoscopic submucosal dissection (ESD) is known to be effective for superficial esophageal squamous cell carcinoma (SCC) and esophagogastric junction (EGJ) adenocarcinoma. In recent years, effective treatment outcomes of ESD for adenocarcinoma in Barrett's esophagus have been reported [4][5][6]. We also have reported effective long-term outcomes of ESD for adenocarcinoma of EGJ including SSBE cancer [7].…”

Section: Introductionmentioning

confidence: 64%

“…An en bloc specimen allows accurate pathological evaluation of risk factors for lymph node metastasis and recurrence and is therefore expected to improve treatment outcomes. The disadvantages of ESD over EMR is that it is time consuming and requires high technical expertise, but ESD is widely accepted, and reports on its safety have been published even in Western countries [5,6]. Thus, ESD followed by RFA has the potential to reduce the long-term risk of Barrett's esophagus recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

et al. 2018

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Background: In recent years, effective outcomes of endoscopic submucosal dissection (ESD) for esophagogastric junction cancer including short-segment Barrett’s esophagus (SSBE) cancer have been reported. However, the efficacy of ESD for long-segment Barrett’s esophagus (LSBE) cancer is unknown. Aim: To clarify the treatment outcomes of ESD for LSBE cancer versus SSBE cancer. Methods: A total of 86 patients with 91 superficial Barrett’s esophageal adenocarcinomas who underwent ESD were enrolled; of these, 68 had underlying SSBE and 18 had LSBE. Procedure outcomes and prognosis were compared. Results: There was no significant difference in age and tumor diameter among patients. The only complication observed was stricture, but it was not significant (2 vs. 9%). No significant difference was observed in the negative horizontal margin rates (94.1 vs. 95.7%), R0 resection rates (83.8 vs. 82.6%), curative resection rates (72.1 vs. 73.9%), and noncurative factors. Both LSBE and SSBE cancer showed favorable 3-year overall survival rates (95.0 vs. 94.4%) in the median observation period of 28.5 months. Conclusions: ESD for LSBE cancer achieved procedure outcomes and short-term prognosis comparable to SSBE. ESD has the potential to be an effective therapeutic option for esophageal neoplasms in patients with LSBE.

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Section: Introductionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

et al. 2018

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“…Results can, however, be difficult to compare among studies especially because the outcome parameters are not standardized yet: ''Curative resection of EAc'' is for instance not always reported, or the ''R0 resection'' follows several definitions; R0 resection might refer to margins free of cancer or of any kind of dysplastic Barrett's. 20,23,24 Since ESD is primarily aiming at treating cancer, we chose, along with other authors, 1,21 to define R0 resection as cancer-free margins. Our figures, as well as those of other teams, are disappointing, especially when compared to the outcomes of ESD in squamous cell carcinoma or adenocarcinomas of the gastric cardia, where R0 resection rates reach 89%-91.9%, in Japan but also in Europe.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Therefore, many authors suggest extending the delineation margins 5 to 10 mm away from the visible lesion. 20,24,27 Our choice of only 2-3 mm lateral safety margins was made by analogy with ESD procedures in other organs. It might have accounted for the 17.2% cancer-infiltrated lateral margins we found, even though the mean resection was 51.3 mm for a mean lesion size (on histopathological examination) of 12 mm.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for early Barrett’s neoplasia

et al. 2016

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Introduction: The possible benefit of endoscopic submucosal dissection (ESD) for early neoplasia arising in Barrett's esophagus remains controversial. We aimed to assess the efficacy and safety of ESD for the treatment of early Barrett's neoplasia. Methods: All consecutive patients undergoing ESD for the resection of a visible lesion in a Barrett's esophagus, either suspicious of submucosal infiltration or exceeding 10 mm in size, between February 2012 and January 2015 were prospectively included. The primary endpoint was the rate of curative resection of carcinoma, defined as histologically complete resection of adenocarcinomas without poor histoprognostic factors. Results: Thirty-five patients (36 lesions) with a mean age of 66.2 AE 12 years, a mean ASA score of 2.1 AE 0.7, and a mean C4M6 Barrett's segment were included. The mean procedure time was 191 AE 79 mn, and the mean size of the resected specimen was 51.3 AE 23 mm. En bloc resection rate was 89%. Lesions were 12 AE 15 mm in size, and 81% (29/36) were invasive adenocarcinomas, six of which with submucosal invasion. Although R0 resection of carcinoma was 72.4%, the curative resection rate was 66% (19/29). After a mean follow-up of 12.9 AE 9 months, 16 (45.7%) patients had required additional treatment, among whom nine underwent surgical resection, and seven further endoscopic treatments. Metachronous lesions or recurrence of cancer developed during the follow-up period in 17.2% of the patients. The overall complication rate was 16.7%, including 8.3% perforations, all conservatively managed, and no bleeding. The 30-day mortality was 0%. Conclusion: In this early experience, ESD yielded a moderate curative resection rate in Barrett's neoplasia. At present, improvements are needed if ESD is to replace piecemeal endoscopic mucosal resection in the management of Barrett's neoplasia.

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“…In contrast, data on esophageal ESD as a therapy for BE and early EAC are limited and consist largely of relatively small retrospective case series 16 17 18 19 20. Only two prospective studies were published in Europe consisting of 55 and 87 patients with early EAC 21 22.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrett’s esophagus: a Western center experience

et al. 2016

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Background and study aims: Endoscopic submucosal dissection (ESD) carries significant advantages over endoscopic mucosal resection. As such, ESD is an established therapy for esophageal squamous cell carcinoma but there are only limited data on ESD as therapy for Barrett’s esophagus (BE). Thus, we prospectively evaluated the outcomes of ESD in patients with BE with high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) performed in a Western center. Patients and methods: This is a prospective cohort study. Indications for ESD included: (1) early EAC defined as lesions with intramucosal cancer or superficial submucosal invasion; (2) early EAC with positive lateral margin after EMR; and (3) nodularity with HGD that could not be removed en-bloc with EMR Results: From October 2013 to July 2015, 36 consecutive patients (median age 69, 32 males) underwent ESD at our center. Median procedure time was 88 minutes, with median maximal diameter of resected specimens of 49 mm. En-bloc, R0, and curative resection rates were 100 %, 81 %, and 69 %, respectively. Intramucosal EAC was found in 13 patients (36 %), and submucosal invasion in 13 patients (36 %). In 59 % of the cases, there was discrepancy in the pre- and post-ESD histopathologic diagnosis.Adverse events occurred in 8 patients (22 %), including one episode of bleeding treated with endoscopy and seven esophageal strictures, which were successfully managed with dilations. Conclusions: ESD for BE with HGD/early EAC is feasible and safe with resulting very high en-bloc and R0 resection rates. ESD provided for more accurate pathologic evaluation and significant discrepancy between the pre- and post-ESD histopathological diagnosis was noted.

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Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia

Abstract: ESD appears to be safe and effective, with a high rate of curative resection of carcinoma. ESD should be considered for patients with Barrett's neoplasia at risk of incomplete resection or poor pathologic assessment with conventional EMR.

Cited by 83 publications

References 39 publications

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Endoscopic submucosal dissection for early Barrett’s neoplasia

Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrett’s esophagus: a Western center experience

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