Complicated Barrett’s Lesions and Subsequent Endoscopic Eradication Therapy: A Single Centre Irish Experience

Aims Endoscopic eradication therapy (EET), combining endoscopic mucosal resection (EMR)/submucosal dissection (ESD) with ablation, is the preferred treatment for complex Barrett's lesions, aiding diagnosis, staging and potential eradication of mucosal dysplasia/neoplasia. ESD offers lateral margin data but has associated procedure risks. EMR demonstrates comparable EET efficacy to ESD with an increased safety profile. We aim to review deep margin clearance post EMR for Barrett’s related lesions and subsequent histological clearance post EET.

Methods Retrospective review (January 2019 – October 2023) included Barrett's patients undergoing initial EMR for visible lesions. The study assessed EMR method, histology, margin clearance, nature of ablation, EET clearance and complications. Patients with prior EMR/EET were excluded.

Results 398 patients were identified with Barrett’s diagnosis via “Follow up: dysplasia” filter on ‘Endoraad’ endoscopic software. 63 patients (58 male; 5 female; mean age: 67) were eligible. 100% had dysplastic/neoplastic histology (4.7% low-grade dysplasia (LGD); 44.4% high-grade dysplasia (HGD); 49.2% intramucosal carcinoma: pT1a: 42.8%; pT1b: 6.3%). 93.7% of EMR achieved negative deep margin clearance. 6.3% had positive deep margins (4 patients: HGD: 1; pT1a: 2; pT1b: 1). 65.1% of patients underwent endoscopy post-EET. EET-clearance was 73.2%. Median time from EMR to EET clearance was 18 months. Procedure-related complication rate was 23.8% (Stricture: 9.5%; Acute bleeding: 7.9%; 3.2% ablation ulceration; 1.6% mucosal tear). No statistical association was identified between ablation voltage and stricture formation/multi-piece EMR and bleeding.

Conclusions EMR with subsequent ablation provides high deep margin clearance rates, leading to complete Barrett’s eradication for the majority of patients in<20 months from index treatment.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024