Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma.

Gastrointestinal Endoscopy

PubMedID: 24565073

Kagemoto K, Oka S, Tanaka S, Miwata T, Urabe Y, Sanomura Y, Yoshida S, Hiyama T, Arihiro K, Chayama K. Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma. Gastrointest Endosc. 2014;80(2):239-45.
BACKGROUND
Advances in diagnostic techniques have allowed early stage detection of superficial Barrett's adenocarcinoma (SBA) as well as resection by endoscopic submucosal dissection (ESD). Few reports exist, however, on the safety and efficacy of ESD for SBA.

OBJECTIVE
To analyze outcomes of ESD for SBA in relation to clinicopathological features of the lesions.

DESIGN
Retrospective study.

SETTING
University hospital.

PATIENTS
Twenty-three patients (21 men, 2 women; mean age, 63 years) with 26 SBAs.

INTERVENTION: ESD. MAIN OUTCOME MEASUREMENTS
We examined outcomes of ESD in relation to the clinicopathological features of SBAs. The main outcomes assessed were en bloc resection rate, operation time, adverse event rates, additional resection rate, and time between ESD and any recurrence.

RESULTS
Twenty lesions (87%) derived from short-segment Barrett's esophagus, and 3 lesions (13%) derived from long-segment Barrett's esophagus. The majority of SBAs (54%) were located in the 0 to 3 o'clock circumferential quadrant. Median tumor size was 15 mm (range 5-60 mm). Macroscopic types were flat elevated (n = 13, 50%), depressed (n = 12, 46%), and protruded (n = 1, 4%). The SBAs appeared red (n = 23, 88%) or normally pale (n = 3, 12%). Under magnifying narrow-band imaging, all SBAs showed an irregular mucosal pattern and an irregular vascular pattern. The endoscopic en bloc resection rate was 100% (26/26), and the pathological en bloc resection rate was 85% (22/26). The median procedure time was 95 minutes (range, 30-210 minutes). Delayed bleeding occurred in 1 case, but there was no perforation. The SBAs were of the differentiated type (n = 25, 96%) or poorly differentiated type (n = 1, 4%). The tumor had invaded the superficial muscularis mucosa (n = 3, 12%), lamina propria mucosa (n = 5, 19%, deep muscularis mucosa (n = 9, 34%), SM1 (n = 3, 12%), and SM2 (n = 6, 23%). Additional surgical resection after ESD was performed in 9 cases, and there were no residual tumors, but 1 lymph node metastasis was found. There were no recurrent tumors; however, 1 metachronous adenocarcinoma was diagnosed 42 months after ESD.

LIMITATIONS
Single-center, retrospective study.

CONCLUSIONS
ESD appears to be a safe and effective treatment strategy for early stage SBA.