TY - JOUR
T1 - Extending treatment criteria for Barrett's neoplasia
T2 - results of a nationwide cohort of 138 ESDs
AU - van Munster, Sanne
AU - Verheij, Eva
AU - Nieuwenhuis, Esther
AU - Offerhaus, G J A
AU - Meijer, Sybren
AU - Brosens, Lodewijk A A
AU - Weusten, Bas L A M
AU - Alkhalaf, Alaa
AU - Schenk, B E
AU - Schoon, Erik J
AU - Curvers, Wouter L
AU - van Tilburg, Laurelle
AU - van de Ven, Steffi Elisabeth Maria
AU - Tang, Thjon J
AU - Nagengast, Wouter B
AU - Houben, Martin H M G
AU - Seldenrijk, C A
AU - Bergman, Jacques JGHM
AU - Koch, Arjun Dave
AU - Pouw, Roos E
N1 - Thieme. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - ObjectiveThe use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed inNL.DesignWe retrospectively assessed ESD outcomes in NL, where treatment for BE neoplasia is centralized in 9 expert centers with jointly trained endoscopists and pathologists, and treatment/follow-up data collected in a joint database. ESD is restricted for selected cases.ResultsDuring median 121 minutes (p25-p75 90-180), 130 complete ESDs were performed with 97% (126/130) removed en-bloc. Pathology was HGD (5%), T1a-EAC (43%) or T1b-EAC (52%; 19%sm1, 33%≥sm2). The combined en-bloc and R0 rate was 87% [95%-CI 77-94%] for HGD/T1a-EAC and 49% [37-62%] for T1b-EAC. Upon R1 resection, 29% had residual cancer, in all cases detected at first follow-up endoscopy, while the remaining 71% had no residual cancer in esophagectomy specimen (n=6) or during median 9 months endoscopic FU (p25-p75 4-22) (n=18). Upon R0 resection, local recurrence rate during median 17 months (8-30) was 0% [0-5%]. Adverse events: 1% perforation [0-4%], 3% post-procedural bleeding [1-7%], 13% strictures [8-20%].ConclusionIn expert hands, ESD is safe and allows for removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter is, however, associated with a positive deep resection margin in half of the patients, yet only one third had actual persisting neoplasia at endoscopic FU. To better stratify R1-patients with an indication for additional surgery, repeat endoscopy after healing of the ESD wound may help in predicting residual cancer.
AB - ObjectiveThe use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed inNL.DesignWe retrospectively assessed ESD outcomes in NL, where treatment for BE neoplasia is centralized in 9 expert centers with jointly trained endoscopists and pathologists, and treatment/follow-up data collected in a joint database. ESD is restricted for selected cases.ResultsDuring median 121 minutes (p25-p75 90-180), 130 complete ESDs were performed with 97% (126/130) removed en-bloc. Pathology was HGD (5%), T1a-EAC (43%) or T1b-EAC (52%; 19%sm1, 33%≥sm2). The combined en-bloc and R0 rate was 87% [95%-CI 77-94%] for HGD/T1a-EAC and 49% [37-62%] for T1b-EAC. Upon R1 resection, 29% had residual cancer, in all cases detected at first follow-up endoscopy, while the remaining 71% had no residual cancer in esophagectomy specimen (n=6) or during median 9 months endoscopic FU (p25-p75 4-22) (n=18). Upon R0 resection, local recurrence rate during median 17 months (8-30) was 0% [0-5%]. Adverse events: 1% perforation [0-4%], 3% post-procedural bleeding [1-7%], 13% strictures [8-20%].ConclusionIn expert hands, ESD is safe and allows for removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter is, however, associated with a positive deep resection margin in half of the patients, yet only one third had actual persisting neoplasia at endoscopic FU. To better stratify R1-patients with an indication for additional surgery, repeat endoscopy after healing of the ESD wound may help in predicting residual cancer.
U2 - 10.1055/a-1658-7554
DO - 10.1055/a-1658-7554
M3 - Article
C2 - 34592769
SN - 0013-726X
VL - 54
SP - 531
EP - 541
JO - Endoscopy
JF - Endoscopy
IS - 6
ER -