Post written by Yusuke Fujiyoshi, MD, from the Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada.

EMR and endoscopic submucosal dissection (ESD) are both accepted resection strategies for Barrett’s esophagus—related neoplasia and esophageal adenocarcinoma (EAC). This study aimed to systematically review and synthesize the evidence comparing EMR versus ESD in treating Barrett’s neoplasia and EAC. A limited number of studies have directly compared the 2 methods, and consensus is lacking for which technique should be the first choice when treating Barrett’s neoplasia and EAC.

Data showed significantly higher en bloc resection rates with ESD (odds ratio [OR], 31.53; 95% confidence interval [CI], 10.02-99.19; P < .01; 7 studies]. R0 resection rates were significantly higher with ESD (OR, 5.92; 95% CI, 2.75-12.77; P < .01; 8 studies]. Curative resection rates tended to be higher with ESD (OR, 3.49; 95% CI, 0.86-14.14; P = .080; 4 studies].

There was no significant difference in complete remission of dysplasia rates (OR, 0.92; 95% CI, 0.37-2.26; P = .86; 3 studies]. Local recurrence rates tended to be lower with ESD (OR, 0.35; 95% CI, 0.11-1.04; P = .058; 10 studies]. As for adverse events, there was no significant difference in bleeding, perforation, or postoperative stricture rates.

This systematic review and meta-analysis demonstrates that ESD achieves higher en bloc, R0, and curative resection rates, with a tendency toward lower recurrence rates. These results suggest that ESD may be a more effective option for managing Barrett’s neoplasia and EAC.

Graphical abstract

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