PDF icon PDF herunterladen
Open Access
CC BY 4.0 · Endosc Int Open 2025; 13: a24222815
DOI: 10.1055/a-2422-2815
Original article

Journey to complete remission of dysplasia and intestinal metaplasia after ESD and EMR of Barrett’s esophagus-related neoplasia

Abel Joseph  ‡
1   Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States (Ringgold ID: RIN2569)
2   Division of Gastroenterology and Hepatology, Stanford University, Stanford, United States (Ringgold ID: RIN6429)
,
Kornpong Vantanasiri‡
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Rohit Goyal
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Nikita Garg
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Cadman Leggett
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
D. Chamil Codipilly
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Kenneth Wang
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
William S. Harmsen
4   Biostatistics, Mayo Clinic, Rochester, MN, USA, Rochester, United States
,
John J. Vargo
5   Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic Foundation, Cleveland, United States
,
Sunguk Jang
6   Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
,
Prasad Iyer   *
3   Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Amit Bhatt   *
6   Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, United States (Ringgold ID: RIN2569)
› Institutsangaben
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Background and study aims

Although endoscopic submucosal dissection (ESD) is associated with higher en-bloc and R0 resection rates than cap-assisted endoscopic mucosal resection (cEMR), its comparative impact on achieving complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) in BE endoscopic eradication therapy (EET) is not well defined. We aimed to compare the journey of patients from initial endoscopic resection (ER) with ESD and cEMR to achieving CRD and CRIM.

Patients and methods

Patients undergoing ESD or cEMR followed by ablation for BE neoplasia at two academic institutions in the United States were included. Primary outcomes included CRD and CRIM rates following ER in the two groups. Secondary outcomes included the number of resection/ablative procedures from initial ER to achieving CRD and CRIM. Inverse probability treatment weighting (IPTW) was used to balance confounding variables between groups.

Results

A total of 801 patients (606 cEMR, 195 ESD) were included. ESD group patients had higher en-bloc resection rates (ESD 94.4%, cEMR 44.7%). Higher rates of CRD were observed in patients undergoing initial ESD (HR 1.53, P < 0.01). With time-to-event and IPTW analyses, rates of achieving CRD and CRIM were comparable between the groups. There were no significant differences in mean number of endoscopic resection or ablative procedures among patients undergoing initial cEMR resection compared with those treated with initial ESD.

Conclusions

Despite larger lesion sizes and more cancers in patients undergoing ESD, the EET journey to achieving CRD and CRIM was comparable to that in patients receiving cEMR. Prospective studies are required to further study differences between these two treatment approaches.

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Endoscopic resection (ESD, EMRc, ...)

* Shared last authorship.


Supplementary Material



Publikationsverlauf

Eingereicht: 25. März 2024

Angenommen nach Revision: 25. September 2024

Accepted Manuscript online:
17. März 2025

Artikel online veröffentlicht:
12. Mai 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Abel Joseph, Kornpong Vantanasiri, Rohit Goyal, Nikita Garg, Cadman Leggett, D. Chamil Codipilly, Kenneth Wang, William S. Harmsen, John J. Vargo, Sunguk Jang, Prasad Iyer, Amit Bhatt. Journey to complete remission of dysplasia and intestinal metaplasia after ESD and EMR of Barrett’s esophagus-related neoplasia. Endosc Int Open 2025; 13: a24222815.
DOI: 10.1055/a-2422-2815
 

  • References

  • 1 Cao Y, Liao C, Tan A. et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
    Suche in Google Scholar
  • 2 Sekiguchi M, Igarashi A, Mizuguchi Y. et al. Cost-effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection. Dig Endosc 2022; 34: 553-568
    Suche in Google Scholar
  • 3 Singh RR, Desai M, Bourke M. et al. Real-world evidence of safety and effectiveness of Barrett's endoscopic therapy. Gastrointest Endosc 2023; 98: 155-161 e1
    Suche in Google Scholar
  • 4 Joseph A, Raja S, Kamath S. et al. Esophageal adenocarcinoma: A dire need for early detection and treatment. Cleveland Clin J Med 2022; 89: 269-279
    Suche in Google Scholar
  • 5 Mejia Perez LK, Yang D, Draganov PV. et al. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study. Endoscopy 2022; 54: 439-446
    Suche in Google Scholar
  • 6 Joseph A, Draganov PV, Maluf-Filho F. et al. Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study. Gastrointest Endosc 2022; 96: 445-453
    Suche in Google Scholar
  • 7 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
    Suche in Google Scholar
  • 8 Belghazi K, Pouw RE, Bergman JJ. In the expanding arena of endoscopic management for Barrett's neoplasia, how should we fit in endoscopic submucosal dissection?. Gastrointest Endosc 2018; 87: 1394-1395
    Suche in Google Scholar
  • 9 Iyer PG, Chak A. Surveillance in Barrett's esophagus: Challenges, progress, and possibilities. Gastroenterology 2023; 164: 707-718
    Suche in Google Scholar
  • 10 Yang D, Zou F, Xiong S. et al. Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis. Gastrointest Endosc 2018; 87: 1383-1393
    Suche in Google Scholar
  • 11 Ning B, Abdelfatah MM, Othman MO. Endoscopic submucosal dissection and endoscopic mucosal resection for early stage esophageal cancer. Ann Cardiothorac Surg 2017; 6: 88-98
    Suche in Google Scholar
  • 12 Codipilly DC, Dhaliwal L, Oberoi M. et al. Comparative outcomes of cap assisted endoscopic resection and endoscopic submucosal dissection in dysplastic Barrett's esophagus. Clin Gastroenterol Hepatol 2022; 20: 65-73 e61
    Suche in Google Scholar
  • 13 Namasivayam V, Wang KK, Prasad GA. Endoscopic mucosal resection in the management of esophageal neoplasia: Current status and future directions. Clin Gastroenterol Hepatol 2010; 8: 743-754
    Suche in Google Scholar
  • 14 Sawas T, Visrodia KH, Zakko L. et al. Clutch cutter is a safe device for performing endoscopic submucosal dissection of superficial esophageal neoplasms: a western experience. Dis Esophagus 2018; 31
    Suche in Google Scholar
  • 15 Genere JR, Priyan H, Sawas T. et al. Safety and histologic outcomes of endoscopic submucosal dissection with a novel articulating knife for esophageal neoplasia. Gastrointestinal Endoscopy 2020; 91: 797-805
    Suche in Google Scholar
  • 16 Joseph A, Bhatt A. Endoscopic Submucosal dissection: Upper gastrointestinal tract. In: Kroh M, Docimo Jr S, El Djouzi S. et al. , ed. The SAGES Manual Operating Through the Endoscope. Cham: Springer International Publishing; 2023: 441-469
    Suche in Google Scholar
  • 17 Subramaniam S, Kandiah K, Chedgy F. et al. The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia. Dis Esophagus 2018; 31
    Suche in Google Scholar
  • 18 Doumbe-Mandengue P, Pellat A, Belle A. et al. Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma. Clin Res Hepatol Gastroenterol 2023; 47
    Suche in Google Scholar
  • 19 Vantanasiri K, Joseph A, Sachdeva K. et al. Rates of recurrent intestinal metaplasia and dysplasia after successful endoscopic therapy of Barrett's neoplasia by endoscopic mucosal resection vs endoscopic submucosal dissection and ablation: A large North American multicenter cohort. Am J Gastroenterol 2024; 119: 1831-1840
    Suche in Google Scholar
  • 20 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
    Suche in Google Scholar