Endoscopy 2022; 54(05): 439-446
DOI: 10.1055/a-1541-7659
Original article

Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study

1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Dennis Yang
2   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Peter V. Draganov
2   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Salmaan Jawaid
3   Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
,
Amitabh Chak
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
John Dumot
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
4   Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
,
John J. Vargo
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Sunguk Jang
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
Neal Mehta
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
,
5   Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
,
Tiffany Chua
5   Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
,
Moamen Gabr
6   Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
,
Praneeth Kudaravalli
6   Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
,
Hiroyuki Aihara
7   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
8   Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
,
Saowanee Ngamruengphong
9   Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Milad Pourmousavi Khoshknab
9   Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
,
1   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
› Author Affiliations

Abstract

Background The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia.

Methods We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan–Meier curve was used to compare the groups.

Results 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75–30) and 8 (2–18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001).

Conclusions ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.

Figs. 1 s, 2 s, Tables 1 s, 2 s



Publication History

Received: 19 November 2020

Accepted after revision: 14 June 2021

Publication Date:
27 August 2021 (online)

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