Endoscopic resection of low-grade dysplasia Barrett’s esophagus: A multicenter retrospective study

Aims Barrett’s esophagus (BE) is a common precancerous condition requiring surveillance or treatment in various stages. Low-grade dysplasia (LGD) is a known risk factor for progression to high-grade dysplasia or esophageal adenocarcinoma [1], and the optimal management remains under debate in current guidelines [2]. The unpredictability of the progression poses a risk of underestimating the advancement of dysplasia. Endoscopic resection, has emerged as a potentially advantageous approach due to its high efficacy, low incidence of complications, and shorter duration. This study aimed to evaluate the effectiveness of endoscopic eradication in patients with Barrett’s esophagus and LGD.

Methods This retrospective study, conducted across three tertiary centers, included 119 patients diagnosed with low-grade dysplasia (LGD) in Barrett’s esophagus. In 87% of cases (n=102), the diagnosis was confirmed by two pathologists, and in 70% of cases (n=84), a second biopsy also tested positive for LGD prior to the initiation of treatment. All patients underwent either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The primary outcome was complete eradication of LGD, assessed through both endoscopic evaluation and histopathological confirmation. Secondary outcomes included the rates of adverse events, histopathological characteristics of resected specimens, treatment duration, and dysplasia recurrence.

Results The study population consisted of 75% men (n=89) and 25% women (n=30), with a mean age of 62 years (SD=11). The median extent of Barrett’s esophagus (BE), according to the Prague classification, was C1M3 (n=109). EMR was performed in 97% of patients (n=116), while ESD was used in 3 cases. The median number of endoscopic resection sessions per patient was 1 (IQR=1). LGD was successfully eradicated in 95% of patients (n=113). Histopathology of the resected specimens confirmed LGD in 50% of the patients (n=59), while 9% (n=11) presented high-grade dysplasia, 3% (n=4) had adenocarcinoma, 20% (n=24) showed simple metaplasia, 16% (n=19) had normal mucosa, 0.8% (n=1) had squamous cell carcinoma, and 0.8% (n=1) had a hyperplastic polyp. Early adverse events (AE) occurred in 2.5% of cases (n=3), and late AE were reported in 12% of cases (n=14). Recurrence of LGD was observed in 10% of patients (n=13), with a median follow-up period of 905 days (IQR=1385).

Conclusions Endoscopic therapy through EMR or ESD, appears highly effective in eradicating LGD in patients with Barrett’s esophagus, with a low recurrence rate and an excellent safety profile. Given the histopathological findings that a subset of patients may harbor more advanced dysplasia, endoscopic treatment also provides critical diagnostic insights and can lead to more adapted follow-ups. These results support the consideration of endoscopic resection as a primary intervention for LGD in Barrett’s esophagus, potentially reducing the risk of progression to high-grade dysplasia or cancer.

Publication History

Article published online:
27 March 2025

• References

• 1 Harrison M, Allen JE, Gorrepati VS, López-Jamar JME, Sharma P.. Management of Barrett’s esophagus with low-grade dysplasia Diseases of the Esophagus 2018; 31 (4) doy004.
• 2 Kestens C, Offerhaus GJA, van Baal JWPM, Siersema PD.. Patients With Barrett’s Esophagus and Persistent Low-grade Dysplasia Have an Increased Risk for High-grade Dysplasia and Cancer. Clin Gastroenterol Hepatol 2016; 14 (7): 956-962.e1