Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma

Kagemoto, Kenichi; Oka, Shiro; Tanaka, Shinji; Miwata, Tomohiro; Urabe, Yuji; Sanomura, Yoji; Yoshida, Shigeto; Hiyama, Toru; Arihiro, Koji; Chayama, Kazuaki

doi:10.1016/j.gie.2014.01.022

Cited by 59 publications

(53 citation statements)

References 31 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: 63%

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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: 63%

“…Reports of subsquamous adenocarcinoma recurrence that is difficult to endoscopically treat are not uncommon [12]. In Japan, complete tumor resection by ESD is preferred, but most reports on ESD outcomes for Barrett's esophageal adenocarcinoma mainly consist of SSBE cancer [2,4]. The efficacy of ESD for LSBE cancer is still unknown.…”

Section: Introductionmentioning

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%

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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“…The rate of post-ESD bleeding in the stomach has been reported to range between 0 and 15.6 % [6,7], which is higher than the rate of post-ESD bleeding in the colon (1.5-6.6 %) [7][8][9][10][11] and esophagus (0-5.2 %) [7,12,13]. Previous studies have shown that tumor location, size, and noncoagulated vessels exposed on the ESD ulcer bed are significantly associated with a higher rate of post-ESD bleeding in the stomach [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Postoperative bleeding after gastric endoscopic submucosal dissection in patients receiving antithrombotic therapy

et al. 2016

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Background and aims It is controversial whether antithrombotic therapy increases the risk of bleeding after endoscopic submucosal dissection (ESD). The aim of this study was to evaluate the effects of antithrombotic therapy on gastric ESD. Methods Patients who underwent gastric ESD at Toranomon Hospital between April 2005 and July 2014 were enrolled. The risk of post-ESD bleeding was evaluated by multivariate logistic regression analysis. Results Of 1781 patients enrolled, 253 were taking an antithrombotic; 186 discontinued taking a single antithrombotic (n = 150) or multiple antithrombotics (n = 36) before ESD, whereas 15 continued taking a single antiplatelet agent and another 52 switched to heparin alternative therapy during the peri-ESD period. Post-ESD bleeding occurred in 101 patients (5.7 %): 68 patients (3.8 %) who did not take an antithrombotic, 11 patients (7.3 %) who discontinued taking a single antithrombotic, six patients (16.7 %) who discontinued taking multiple antithrombotics, one patient (6.7 %) who continued taking a single antiplatelet agent, and 15 patients (28.8 %) who switched to heparin therapy. In multivariate analysis, heparin alternative therapy [odds ratio (OR) 10.04, 95 % confidence interval (CI) 4. 35-23.16], discontinuation of the use of multiple antithrombotics before ESD (OR 5.44, 95 % CI 2.00-14.79), tumor location in the lower third of the stomach (OR 2.17, 95 % CI: 1.32-3.58), and a long procedure time (100 min or greater; OR 2.00, 95 % CI 1.25-3.20) were independent risk factors for post-ESD bleeding. Among 52 subjects who switched to heparin therapy, one developed acute renal infarction and one developed cerebral bleeding. Conclusions Because heparin alternative therapy significantly increases the risk of post-ESD bleeding and may not decrease the risk of thromboembolic events, other options should be considered for patients receiving anticoagulation therapy.

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Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma

Cited by 59 publications

References 31 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

Postoperative bleeding after gastric endoscopic submucosal dissection in patients receiving antithrombotic therapy

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