Endoscopic resection of low-grade dysplasia Barrett's esophagus: a multicenter retrospective study

Barrett's esophagus (BE) is a common precancerous condition requiring surveillance or treatment at various stages. Low-grade dysplasia (LGD) increases the risk of progression to high-grade dysplasia or esophageal adenocarcinoma, but histopathological assessment is challenging, and progression is unpredictable. Endoscopic resection, through mucosal or submucosal techniques, offers high efficacy, low adverse event rates, and shorter treatment duration. This study evaluated the effectiveness and safety of endoscopic eradication therapy in patients with LGD BE.

This retrospective study included 119 patients with LGD BE treated at 3 tertiary centers. Patients underwent endoscopic mucosal resection (EMR) or, for nodular or retractile lesions, endoscopic submucosal dissection (ESD). The primary outcome was complete LGD eradication (CE-D), confirmed endoscopically and histologically. Secondary outcomes included adverse events, histopathology of resected specimens, treatment duration, and recurrence rates.

Of the 119 patients (75% men; mean age 62 years), EMR was performed in 97% and ESD in 97.5% cases. LGD was confirmed by 2 different pathologists in 87% and by repeat biopsy in 70% before treatment. CE-D was achieved in 95% of patients. Histopathology revealed LGD in 50%, high-grade dysplasia in 9%, adenocarcinoma in 3%, and nondysplastic findings in others. Early adverse events occurred in 2.5%, and late adverse events in 12%, all managed conservatively or endoscopically. LGD recurred in 10% of patients over a median follow-up of 905 days.

Endoscopic therapy with EMR or ESD appears effective and safe for selected patients with LGD in BE, with low recurrence rates. In addition to lesion eradication, it provides histological assessment, allowing detection of more advanced pathology in some cases. These findings suggest that resection may represent a valuable adjunct or alternative within current treatment strategies.