Complete endoscopic resection for Barrett’s HGD and/or early cancer

Bahin_headshotFarzan F. Bahin, MBBS (Hons), FRACP, MPhil, from the Department of Gastroenterology and Hepatology, Westmead Hospital, in Sydney, New South Wales, Australia discusses this Original Article, “Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma.”

The optimal therapy for Barrett’s high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EEA) is still being determined. Complete endoscopic resection of Barrett’s allows for accurate histologically staging, controlled Barrett’s elimination and ability to detect covert synchronous carcinoma. Because the long-term outcomes of such a strategy are not well defined, we wanted to evaluate this through analysis of prospectively collected data.

At mean follow up of over 40 months intention-to-treat complete remission of HGD/EEA, dysplasia, and intestinal metaplasia was achieved in 98.5%, 89.1%, and 71.0%, respectively. In 47.1% of patients, CER changed the histological grade compared with pre-treatment biopsies (28.1% downstaged and 19.0% upstaged). Esophageal dilation was performed in 36.8% at a mean of 2.5 sessions. At the end of follow-up, 96.4% of patients had no or minimal dysphagia and 90.6% of patients found CER an acceptable treatment. Covert synchronous EEA was found in 1 patient.

Figure 4. A, A Paris 0-IIb abnormal area at 3 o’clock arising within a 2 cm in circumferential length and 4 cm in maximal length segment of Barrett’s esophagus is resected and shows high-grade dysplasia. Repeat endoscopy at 6 weeks shows neosquamous mucosa at the site of focal resection. Second-stage subtotal endoscopic resection is performed. B, At 9 o’clock, a minor area of Barrett’s mucosa has not been removed (arrow). At progress endoscopy near total neosquamous epithelialization is achieved. C, The untreated area at 9 o’clock manifests as a residual Barrett’s island (arrow). D, This area is treated with argon plasma coagulation.

Complete endoscopic resection is a feasible, safe and durable strategy for the management of Barrett’s neoplasia. It is an important alternative to radiofrequency ablation with significant diagnostic and therapeutic benefits. Safe and effective therapies to prevent endoscopic resection related stricture formation are required and may shift the balance of first line treatment of complete Barrett’s elimination toward endoscopic resection.

Find the abstract for this article here.

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