Long-term Efficacy and Safety of Endoscopic Resection for Patients With Mucosal Adenocarcinoma of the Esophagus

Pech, Oliver; May, Andrea; Manner, Hendrik; Behrens, Angelika; Pohl, Jürgen; Weferling, Maren; Hartmann, Urs; Manner, Nicola; Huijsmans, Josephus; Goßner, Liebwin; Rabenstein, Thomas; Vieth, Michael; Stolte, Manfred; Ell, Christian

doi:10.1053/j.gastro.2013.11.006

Cited by 437 publications

(333 citation statements)

References 28 publications

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“…Patients with nodular BE are initially treated with EMR as a diagnostic and therapeutic strategy. If the margins are negative without deeper invasion, then the remaining BE is treated with RFA (36,37). Endoscopic submucosal dissection (ESD) is another excellent diagnostic and therapeutic approach for BE and mucosal carcinoma patients.…”

Section: Treatmentmentioning

confidence: 99%

Overview of esophageal cancer

Abbas¹,

Krasna²

2017

Ann. Cardiothorac. Surg.

181

168

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Esophageal cancer is a male-dominant aggressive malignancy and a leading cause of cancer-related mortality worldwide. Squamous cell carcinoma and adenocarcinoma are the two predominant histological subtypes with varying geographical and racial distribution. Globally, squamous cell carcinoma remains the most common histological type. In Western countries, however, adenocarcinoma has become the leading histological subtype, corresponding to a rise in the incidence of obesity, gastro-esophageal reflux disease and Barrett's esophagus. The risk of esophageal adenocarcinoma conferred by Barrett's esophagus depends on factors such as genomic instability, race and gender of the patient. Treatment requires a multidisciplinary team approach and optimal therapy is still debated. Endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection, have become the standard treatment modality for Barrett's esophagus and early carcinoma. Multimodal treatment, which includes chemotherapy, radiation therapy followed by surgical resection or without surgical resection, in varying orders remains the main mode of treatment for most patients. Minimally invasive surgical approaches have become the standard for esophagectomy and the current literature has demonstrated similar oncological outcomes with reduced morbidity. Recently, there has been a modest improvement in the overall survival of patients with esophageal cancer.

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Section: Treatmentmentioning

confidence: 99%

Overview of esophageal cancer

Abbas¹,

Krasna²

2017

Ann. Cardiothorac. Surg.

181

168

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“…Therefore, lesions are resected piecemeal, leaving remnants of neoplastic tissue in situ, and recurrence rates of 9.8% to 14.5% require cautious follow-up and additional endoscopic resections. 9,10 In 2010, Takahashi et al reported a 99.1% curative resection rate for intramucosal esophageal squamous cell carcinoma resected with ESD, as compared to 78.3% obtained with EMR, even though the lesions resected by EMR were almost twice as small as those resected with ESD. 10 The superiority of ESD over EMR in terms of en bloc resection, curative resection, and local recurrence rate of esophageal neoplasms was confirmed in three large studies [10][11][12] as it had been demonstrated earlier for gastric neoplasms.…”

Section: Introductionmentioning

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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“…MBM has been shown to be quicker and less expensive than the cap technique, with comparable safety and efficacy (64). An analysis of 1,000 patients with intramucosal EAC treated with EMR reported a complete response in 96.3% of patients after a median follow up period of 5 years (65). ESD was initially developed in Japan to treat early gastric cancer.…”

Section: Ermentioning

confidence: 99%

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

Mansour

El–Serag

Anandasabapathy

2017

Ann. Cardiothorac. Surg.

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Barrett's esophagus (BE) is a premalignant condition that increases the risk of esophageal adenocarcinoma (EAC). Significantly more common in the Western world, risk factors include increased age, male sex, white race, gastro-esophageal reflux disease (GERD), central obesity, and cigarette smoking. The rates of progression to cancer depend on the grade of Barrett's dysplasia. Screening for BE is recommended in patients with GERD and additional risk factors. Endoscopic surveillance of patients with BE likely improves overall outcomes. Advanced endoscopic imaging can help increase the efficiency of current endoscopic surveillance.Endoscopic therapy is safe and effective for the treatment of dysplastic BE and intramucosal EAC, but ongoing surveillance following treatment is necessary. This review will cover screening, surveillance, advanced imaging, chemoprevention, endoscopic treatment, and post-treatment surveillance of BE.

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Long-term Efficacy and Safety of Endoscopic Resection for Patients With Mucosal Adenocarcinoma of the Esophagus

Cited by 437 publications

References 28 publications

Overview of esophageal cancer

Overview of esophageal cancer

Endoscopic submucosal dissection for early Barrett’s neoplasia

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

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