Endoscopy 2022; 54(06): 531-541
DOI: 10.1055/a-1658-7554
Original article

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

 1   Department of Gastroenterology and Hepatology, Amsterdam UMC location VUMC, Amsterdam, The Netherlands
 2   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
,
Eva P. D. Verheij
 1   Department of Gastroenterology and Hepatology, Amsterdam UMC location VUMC, Amsterdam, The Netherlands
,
Esther A. Nieuwenhuis
 1   Department of Gastroenterology and Hepatology, Amsterdam UMC location VUMC, Amsterdam, The Netherlands
,
Johan G. J. A. Offerhaus
 3   Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Sybren L. Meijer
 4   Department of Pathology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
,
Lodewijk A. A. Brosens
 3   Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Bas L. A. M. Weusten
 2   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
 5   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Alaa Alkhalaf
 6   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Ed B. E. Schenk
 6   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Erik J. Schoon
 7   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
 8   GROW: School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
,
Wouter L. Curvers
 7   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
,
 9   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
,
 9   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Thjon J. Tang
10   Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle aan den Ijssel, The Netherlands
,
Wouter B. Nagengast
11   Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Martin H. M. G. Houben
12   Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands
,
Kees C. A. Seldenrijk
13   Department of Pathology, Sint Antonius Hospital, Nieuwegein, The Netherlands
,
Jacques J. G. H. M. Bergman
 1   Department of Gastroenterology and Hepatology, Amsterdam UMC location VUMC, Amsterdam, The Netherlands
,
Arjun D. Koch*
 9   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Roos E. Pouw**
 1   Department of Gastroenterology and Hepatology, Amsterdam UMC location VUMC, Amsterdam, The Netherlands
,
on behalf of the Dutch Barrett Expert Centers › Institutsangaben
Retrospective analysis of prospectively collected data Registration number (trial ID): NL7039 Type of study: Cohort study


Abstract

Background The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett’s esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands.

Methods Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.

Results 130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90–180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %–92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %–60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.

Conclusion In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.

* Shared senior authorship


** Shared senior authorship


Supplementary material



Publikationsverlauf

Eingereicht: 31. März 2021

Angenommen: 30. September 2021

Accepted Manuscript online:
30. September 2021

Artikel online veröffentlicht:
13. Januar 2022

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Belghazi K, Marcon N, Teshima C. et al. Risk factors for serious adverse events associated with multiband mucosectomy in Barrett’s esophagus: an international multicenter analysis of 3827 endoscopic resection procedures. Gastrointest Endosc 2020; 92: 259-268.e2
  • 2 Pouw RE, Beyna T, Belghazi K. et al. A prospective multicenter study using a new multiband mucosectomy device for endoscopic resection of early neoplasia in Barrett’s esophagus. Gastrointest Endosc 2018; 88: 647-654
  • 3 Alvarez Herrero L, Pouw RE, van Vilsteren FG. et al. Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens. Endoscopy 2010; 42: 1030-1036
  • 4 Scholvinck D, Kunzli H, Meijer S. et al. Management of patients with T1b esophageal adenocarcinoma: a retrospective cohort study on patient management and risk of metastatic disease. Surg Endosc 2016; 30: 4102-4113
  • 5 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 2017; 66: 783-793
  • 6 Ohkuwa M, Hosokawa K, Boku N. et al. New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 2001; 33: 221-226
  • 7 Ono H, Kondo H, Gotoda T. et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
  • 8 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
  • 9 Nederlandse vereniging van Maag-Darm-Leverartsen. Gastroenterologists DSo. Richtlijn Barrett-Oesofagus [Guideline Barrett’s esophagus] 2017. Available at: https://www.mdl.nl/barrett-oesofagus
  • 10 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111: 30-50 quiz 51
  • 11 Buskens CJ, Westerterp M, Lagarde SM. et al. Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 2000; 703-710
  • 12 Westerterp M, Koppert LB, Buskens CJ. et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 2005; 446: 497-504
  • 13 Manner H, Pech O, Heldmann Y. et al. The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc 2015; 29: 1888-1896
  • 14 Nieuwenhuis E, van Munster S, Weusten BLAM. et al. Mo1312 Endoscopic follow-up of radically resected high-risk mucosal adenocarcinoma and low- and high-risk submucosal adenocarcinoma arising in Barrett’s esophagus, results of 120 patients from the Dutch Barrett Expert Center cohort. Gastroenterology 2020; 1586: 845
  • 15 van Munster S, Nieuwenhuis E, Weusten B. et al. Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation +/- endoscopic resection: results from the national Dutch database in a 10-year period. Gut 2021;
  • 16 van Vilsteren FG, Pouw RE, Alvarez Herrero L. et al. Learning endoscopic resection in the esophagus. Endoscopy 2015; 47: 972-979
  • 17 van Vilsteren FG, Pouw RE, Herrero LA. et al. Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program. Endoscopy 2012; 44: 4-12
  • 18 van der Wel MJ, Klaver E, Duits LC. et al. Adherence to pre-set benchmark quality criteria to qualify as expert assessor of dysplasia in Barrett’s esophagus biopsies – towards digital review of Barrett’s esophagus. United European Gastroenterol J 2019; 7: 889-896
  • 19 van der Wel MJ, Duits LC, Klaver E. et al. Development of benchmark quality criteria for assessing whole-endoscopy Barrett’s esophagus biopsy cases. United European Gastroenterol J 2018; 6: 830-837
  • 20 Klaver E, van der Wel M, Duits L. et al. Performance of gastrointestinal pathologists within a national digital review panel for Barrett’s oesophagus in the Netherlands: results of 80 prospective biopsy reviews. J Clin Pathol 2021; 74: 48-52
  • 21 Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg 2017; 6: 119-130
  • 22 van der Wel MJ, Klaver E, Pouw R. et al. Significant variation in histopathological assessment of endoscopic resections for Barrett’s neoplasia suggests need for consensus reporting: propositions for improvement. Dis Esoph 2021; Online ahead of print
  • 23 Integraal Kankercentrum Nederland (IKNL). Oesofaguscarcinoom: landelijke richtlijn, versie 3.1. [Esophageal cancer: national guideline, version 3.1]. 2015 Available at: https://richtlijnendatabase.nl/richtlijn/oesofaguscarcinoom/behandeling/neoadjuvante_behandelingen/neoadjuvante_chemoradiotherapie.html
  • 24 Gotink AW, van de Ven SEM, ten Kate FJC. et al. Individual risk calculator to predict lymph node metastases in patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study. Endoscopy 2021; Online ahead of print