Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic review and pooled analysis

Desai, Madhav; Saligram, Shreyas; Gupta, Neil; Vennalaganti, Prashanth; Bansal, Ajay; Choudhary, Abhishek; Vennelaganti, Sreekar; He, Jia; Titi, Mohammad; Maselli, Roberta; Qumseya, Bashar J.; Olyaee, Mojtaba; Waxman, I.; Repici, Alessandro; Hassan, Cesare; Sharma, Prateek

doi:10.1016/j.gie.2016.09.022

Cited by 134 publications

(96 citation statements)

References 46 publications

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“…RFA is a good ablative method with high safety and efficacy. Local resection for neoplasia by EMR followed by ablation with RFA for residual Barrett's epithelium showed good outcomes in a recent study and is recommended in Western countries [10]. However, EMR followed by RFA tends to have subsquamous recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Effective outcomes of EMR with RFA have been reported in recent studies [9,10], and this multimodality approach is widely accepted. However, piecemeal resection by EMR can lead one to overlook important pathological findings; therefore, it is considered a significant risk factor for local recurrence [11].…”

Section: Introductionmentioning

confidence: 99%

“…However, piecemeal resection by EMR can lead one to overlook important pathological findings; therefore, it is considered a significant risk factor for local recurrence [11]. Therefore, EMR followed by RFA poses a long-term potential risk of recurrence with a reported adenocarcinoma recurrence rate of 1.4% [10]. Reports of subsquamous adenocarcinoma recurrence that is difficult to endoscopically treat are not uncommon [12].…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…12,19 A recent systematic review comparing serial EMR with EMR plus radiofrequency ablation for eradication of BE with HGD or IMC revealed similar rates of eradication of neoplasia (94.9% v. 93.4%, respectively) and metaplasia (79.6% v. 73.1%) at the expense of a significantly higher rate of structuring (33% v. 10%). 20 Esophageal varices are a potential comorbidity limiting the ability to safely perform EMR. Although our series did not capture this scenario, case reports have described preoperative transjugular intrahepatic portosystemic shunt to decrease portal pressure to diminish varices, allowing for EMR.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma: a Canadian experience

Yamashita

Bethune³

et al. 2017

CJS

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Background: Endoscopic mucosal resection (EMR) is increasingly being used as a first-line treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC). We reviewed our experience with endoscopic treatment of BE with HGD and IMC at our institution with respect to eradication rates, complications and long-term recurrence. Methods:We performed a single-centre retrospective review of all patients referred between October 2010 and August 2014 for EMR with dysplastic BE or IMC. We performed EMR using a cap-fitted endoscope, and the procedure was repeated every 3 months until eradication or progression of disease.Results: A total of 28 patients were identified: 16 with dysplastic BE (14 HGD, 1 low-grade dysplasia, 1 intermediate dysplasia) and 12 with IMC. Complete eradication of HGD was achieved in 11 of 14 (79%) patients. Three of 12 (25%) patients initially referred with suspected IMC were found to have invasive adenocarcinoma on EMR. Eradication was successful in 8 of 9 (89%) patients with true IMC, with 1 patient progressing to salvage esophagectomy. Complications occurred in 2 of 28 (7%) patients; both had esophageal strictures managed with dilatation. Median duration of follow-up was 371 days. Conclusion:Our experience supports the safety of EMR as a first-line treatment for patients with BE with dysplasia and IMC in early short-term follow-up. Résultats : En tout, 28 patients ont été recensés : 16 présentaient un oesophage de Barrett dysplasique (14 DHG, 1 dysplasie de bas grade, 1 dysplasie intermé-diaire) et 12 présentaient un adénocarcinome intramuqueux. Une éradication complète de la DHG a été obtenue chez 11 patients sur 14 (79 %). Chez 3 patients sur 12 (25 %) initialement adressés pour un adénocarcinome intramuqueux, la mucosectomie a révélé un adénocarcinome envahissant. Huit patients sur 9 (89 %) atteints d'un adénocarcinome intramuqueux avéré ont subi le traitement d'éradication avec succès, et 1 patient a dû subir une oesophagectomie de sauvetage. Des complications sont survenues chez 2 patients sur 28 (7 %); les 2 patients ont présenté des sténoses oesophagiennes corrigées par dilatation. La durée médiane du suivi a été de 371 jours. Conclusion :Notre expérience confirme l'innocuité de la mucosectomie endoscopique comme traitement de première intention chez les patients présentant un oesophage de Barrett dysplasique ou un adénocarcinome intramuqueux dans le contexte d'un suivi à court terme.

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“…The result showed that both techniques had equal eradication rate. However, standard EMR had a higher incidence of bleeding, perforation and stricture formation (28).…”

Section: Section B: Emrmentioning

confidence: 98%

Endoscopic submucosal dissection and endoscopic mucosal resection for early stage esophageal cancer

Niu¹,

Abdelfatah²,

Othman³

2017

Ann. Cardiothorac. Surg.

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Mortality from esophageal cancer remains high despite advances in medical therapy. Although the incidence of squamous cell carcinoma of the esophagus remains unchanged, the incidence of the esophageal adenocarcinoma has increased over time. Gastroesophageal reflux disease (GERD and obesity are contributing factors to the development of Barrett's esophagus and subsequent development of adenocarcinoma. Early recognition of the disease can lead to resection of esophageal cancer prior to the development of lymphovascular invasion. Various modalities have been implemented to aid identification of precancerous lesions and early esophageal cancer. Chromoendoscopy, narrowband imaging and endoscopic ultrasound examination are typically used for evaluating early esophageal lesions. Recently, confocal laser endomicroscopy (CLE) and volumetric laser scanning were implemented with promising results. Endoscopic management of early esophageal cancer may be done using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Both techniques allow resection of the mucosa (and possibly a portion of the submucosa) containing the early tumor without interruption of deeper layers. A submucosal injection creating a cushion coupled with snare resection or cap assisted mucosal suction followed by ligation and snare resection are the most common techniques of EMR. EMR can remove lesions less than 2 cm in size en bloc. Larger lesions may require resection in piecemeal fashion. This may limit assessment of the margins of the lesion and orienting the lesion's border. ESD offers en bloc dissection of the lesion regardless of its size. ESD is performed with specialized needle knives, which allow incision followed by careful dissection of the lesion within the submucosal layer. Tumor recurrence after ESD is rare but the technique is labor intensive and has an increased risk of perforation. Esophageal stenosis remains a concern after extensive EMR or ESD. Dilation with balloon or stent placement is usually sufficient to treat post-resection stenosis.

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Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic review and pooled analysis

Cited by 134 publications

References 46 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 mucosal resection for high-grade dysplasia and intramucosal carcinoma: a Canadian experience

Endoscopic submucosal dissection and endoscopic mucosal resection for early stage esophageal cancer

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