Complete circumferential endoscopic submucosal dissection for early Barrett's neoplasia

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is increasingly used for esophageal neoplasia in Western countries.
• Esophageal cancers in North America often arise from Barrett's esophagus.
• Circumferential ESD provides an endoscopic alternative to esophagectomy for advanced neoplasia.

Purpose of the Study:

• To present the experience with complete circumferential esophageal ESD at a North American center.
• To evaluate the feasibility and outcomes of this technique for Barrett's neoplasia.

Main Methods:

• A cohort of 11 patients undergoing 100% circumferential esophageal ESD between October 2016 and January 2023 was analyzed.
• Data collected included demographics, procedural details, and lesion characteristics.
• En-bloc resection was the standard procedural approach.

Main Results:

• All 11 procedures were technically successful with en-bloc resection.
• 82% of patients achieved R0 resection (clear margins).
• 18% developed refractory strictures, managed endoscopically; 64% had adenocarcinoma, with 86% upstaged from initial biopsies.

Conclusions:

• Circumferential ESD is a viable therapeutic option for multifocal dysplastic Barrett's esophagus.
• The procedure demonstrates high success rates and a low incidence of adverse events.
• The risk of post-procedural stricture requires further investigation regarding optimal prophylaxis.