Endoscopic submucosal dissection for early Barrett's neoplasia

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Barrett's esophagus is a precancerous condition associated with an increased risk of esophageal adenocarcinoma.
• Early neoplasia in Barrett's esophagus presents a treatment challenge, with endoscopic techniques evolving.
• The efficacy and safety of endoscopic submucosal dissection (ESD) for early Barrett's neoplasia remain under investigation.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for treating early neoplasia in Barrett's esophagus.
• To determine the rate of curative resection for adenocarcinoma in Barrett's esophagus using ESD.
• To assess complications and outcomes following ESD for Barrett's neoplasia.

Main Methods:

• Prospective inclusion of consecutive patients undergoing ESD for visible lesions in Barrett's esophagus (suspicious for submucosal infiltration or >10 mm).
• Primary endpoint: curative resection rate of carcinoma (histologically complete resection without poor histoprognostic factors).
• Data collected on procedure time, specimen size, resection type, and follow-up outcomes.

Main Results:

• Thirty-five patients (36 lesions) underwent ESD. The en bloc resection rate was 89%.
• The R0 resection rate for carcinoma was 72.4%, with a curative resection rate of 66%.
• Complications occurred in 16.7% (8.3% perforations), with 0% 30-day mortality. 45.7% required additional treatment post-procedure.

Conclusions:

• Endoscopic submucosal dissection (ESD) demonstrated a moderate curative resection rate for early Barrett's neoplasia in this initial experience.
• Current ESD outcomes suggest that further technical or procedural refinements are needed.
• ESD may not yet be a definitive replacement for piecemeal endoscopic mucosal resection in managing Barrett's neoplasia.