Vertical tumor-positive resection margins and the risk of residual neoplasia after endoscopic resection of Barrett's...

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Barrett's neoplasia requires precise management after endoscopic resection (ER).
• Tumor-positive vertical resection margins (R1v) after ER indicate potential for residual disease.
• Accurate assessment of residual neoplasia is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the proportion of residual neoplasia in patients with Barrett's neoplasia after ER with R1v.
• To assess the diagnostic accuracy of endoscopic reassessment for residual neoplasia.
• To inform optimal management strategies for R1v cases.

Main Methods:

• Retrospective cohort study of patients undergoing ER for Barrett's neoplasia with R1v.
• Histological reassessment of resection margins by expert pathologists.
• Endoscopic reassessment and/or surgical resection for evaluation of residual neoplasia.

Main Results:

• Of 74 patients with confirmed R1v, 50% had residual neoplasia detected via endoscopic reassessment or surgery.
• Endoscopic reassessment accurately identified visible residual neoplasia.
• Local recurrence occurred in 16% of patients with R1v during follow-up, detected as visible abnormalities.

Conclusions:

• Residual neoplasia is present in 50% of patients after ER with R1v.
• Histological margin assessment in ER specimens can be challenging.
• Early endoscopic reassessment (8-12 weeks) is effective in detecting residual neoplasia and guiding treatment decisions.