Endoscopy 2018; 50(04): S102-S103
DOI: 10.1055/s-0038-1637332
ESGE Days 2018 ePoster Podium presentations
20.04.2018 – Esophagus 1
Georg Thieme Verlag KG Stuttgart · New York

ESD IN EARLY BARRETT'S ADENOCARCINOMA IS A SAFE PROCEDURE

T Fritz
1   Ordensklinikum Linz/Elisabethinen, Interne 4, Linz, Austria
,
A Ziachehabi
1   Ordensklinikum Linz/Elisabethinen, Interne 4, Linz, Austria
,
F Wewalka
1   Ordensklinikum Linz/Elisabethinen, Interne 4, Linz, Austria
,
R Schöfl
1   Ordensklinikum Linz/Elisabethinen, Interne 4, Linz, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

EMR (endoscopic mucosal resection) is currently considered the therapy of choice for early Barrett's adenocarcinoma, but achieving en bloc resection by EMR is limited to small lesions. By contrast, ESD (endoscopic submucosal dissection) allows en bloc resection irrespective of the tumor's size. This retrospective data collection was aimed to highlight the benefits of ESD with special focus on the procedure's safety.

Methods:

31 patients presenting with suspect lesions for Barrett's adenocarcinoma underwent ESD. 29 patients histologically attested to high grade intraepithelial dysplasia (HGIN, 17.2%) or Barrett's adenocarcinoma (82.8%) were further evaluated.

All procedures were conducted by one investigator (A.Z.).

Results:

En bloc resection was achieved in 93.1% with a mean dissection diameter of 4.1 cm (SEM ± 0.3). R0 resection excluded specimens with HGIN or adenocarcinoma infiltration of the lateral or basal margins and was achieved in 75.9%.

Locally advanced tumor stages (sm2 in 16.7%, L1 in 8.3%) or poor tumor grading (G3 in 25%) enrolled only 65.5% of patients for a feasible endoscopic R0 resection, but among these, this was accomplished in 84.2%.

In only 74.2%, the histology of the dissected specimen corresponded to the biopsy taken preinterventionally, since adenocarcinoma evolved in 13.8% of patients with a negative diagnostic biopsy.

Complications occured in 13.8%: one patient presented with bleeding within 24h after ESD and three patients developed stenosis 3,5 months after the procedure.

Noteworthy, no perforations occured.

Conclusions:

ESD is a safe procedure providing excellent en bloc resection rates and thus yielding relevant curative tumor resection rates. Importantly, en bloc resection allows the

diagnosis of carcinomas that might be ignored by piecemeal EMR.

Notably, endoscopic treatment was unfeasible in more than 1/3 of carcinomas because of locally advanced tumor stages at the time of diagnosis, which underlines the need for earlier tumor detection.