Endoscopy 2022; 54(06): 565-570
DOI: 10.1055/a-1659-3514
Innovations and brief communications

Quantitative analysis of submucosal excision depth in endoscopic resection for early Barrett’s cancer

Jenny Krause
1   Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Thomas Rösch
2   Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Stefan Steurer
3   Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Till Clauditz
3   Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Susanne Sehner
4   Department of Epidemiology and Statistics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Udo Schumacher
5   Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Horst Neuhaus
6   Department of Internal Medicine, Evangelic Hospital Düsseldorf, Düsseldorf, Germany
,
Helmut Messmann
7   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Brigitte Schumacher
6   Department of Internal Medicine, Evangelic Hospital Düsseldorf, Düsseldorf, Germany
8   Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
,
Andreas Probst
7   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Guido Schachschal
1   Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Hanno Ehlken
1   Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Michael Vieth
9   Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
,
Rüdiger Schmitz
1   Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2   Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations


Abstract

Background Following endoscopic resection of early-stage Barrett’s esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens.

Methods In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated.

Results No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections.

Conclusion The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.

Supplementary material



Publication History

Received: 25 August 2020

Accepted: 20 August 2021

Article published online:
02 December 2021

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