Margin clearance and post-procedure ablation decrease recurrence risk in endoscopic mucosal resections for...

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Endoscopic mucosal resection (EMR) is a standard treatment for Barrett's-associated esophageal dysplasia and early cancer.
• Disease recurrence after EMR is a significant clinical concern.
• Identifying factors predicting recurrence is crucial for optimizing patient management.

Purpose of the Study:

• To analyze clinical and histopathologic factors associated with local disease recurrence following EMR for Barrett's-related esophageal neoplasia.
• To assess the impact of post-procedure ablation on recurrence rates.

Main Methods:

• Retrospective analysis of 290 EMR specimens from 129 patients with glandular neoplasia.
• Inclusion of patient demographics, lesion characteristics, margin status, and post-procedure treatments.
• Statistical analysis of 227 eligible cases to identify predictors of local recurrence.

Main Results:

• Adenocarcinoma was the highest-grade lesion in 42% of specimens.
• Recurrence of same or worse disease was observed in 46% of cases.
• Lack of post-procedure ablation was linked to increased recurrence risk for high-grade dysplasia and carcinoma.
• Poor differentiation and positive margin status also increased recurrence risk for carcinoma.

Conclusions:

• Differentiation, margin status, and post-EMR ablation are key determinants of local recurrence risk in Barrett's-related adenocarcinoma.
• Tumor budding and invasion depth did not significantly impact recurrence in this cohort.
• Post-procedure ablation is critical for reducing recurrence rates.