Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study

Abstract

Background The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia.

Methods We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan–Meier curve was used to compare the groups.

Results 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75–30) and 8 (2–18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001).

Conclusions ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.

Publikationsverlauf

Eingereicht: 19. November 2020

Angenommen nach Revision: 14. Juni 2021

Artikel online veröffentlicht:
27. August 2021

• References

• 1 Abrams JA, Sharaiha RZ, Gonsalves L. et al. Dating the rise of esophageal adenocarcinoma: analysis of connecticut tumor registry data, 1940–2007. Cancer Epidemiol Biomarkers Prev 2011; 20: 183-186
• 2 Wani S, Qumseya B, Sultan S. et al. Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer. Gastrointest Endosc 2018; 87: 907-931.e9
• 3 Pech O, Behrens A, May A. et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 2008; 57: 1200-1206
• 4 Cao Y, Liao C, Tan A. et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
• 5 Bhatt A, Abe S, Kumaravel A. et al. Indications and techniques for endoscopic submucosal dissection. Am J Gastroenterol 2015; 110: 784-791
• 6 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
• 7 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25.e1
• 8 Gotoda T, Iwasaki M, Kusano C. et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
• 9 Ono S, Fujishiro M, Niimi K. et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
• 10 Ishihara R, Arima M, Iizuka T. et al. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 2020; 32: 452-493
• 11 Yang D, Coman RM, Kahaleh M. et al. Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc 2017; 86: 600-607
• 12 Yang D, Zou F, Xiong S. et al. Endoscopic submucosal dissection for early Barrett’s neoplasia: a meta-analysis. Gastrointest Endosc 2018; 87: 1383-1393
• 13 Subramaniam S, Chedgy F, Longcroft-Wheaton G. et al. Complex early Barrett’s neoplasia at 3 Western centers: European Barrett’s Endoscopic Submucosal Dissection Trial (E-BEST). Gastrointest Endosc 2017; 86: 608-618
• 14 Probst A, Aust D, Märkl B. et al. Early esophageal cancer in Europe: Endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2015; 47: 113-121
• 15 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-378
• 16 Harris PA, Taylor R, Minor BL. et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; DOI: 10.1016/j.jbi.2019.103208.
• 17 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 2017; 66: 783-793
• 18 Yoshida M, Takizawa K, Nonaka S. et al. Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2020; 91: 55-65.e2
• 19 Abe S, Iyer P, Oda I. et al. Approaches for stricture prevention after esophageal endoscopic resection. Gastrointest Endos 2017; 86: 779-791
• 20 Pech O, May A, Manner H. et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660.e1
• 21 Sharma P, Morales T, Sampliner R. Short segment Barrett’s esophagus-the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol 1998; 93: 1033-1036
• 22 Cotton P, Eisen G, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 23 Chevaux JB, Piessevaux H, Jouret-Mourin A. et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia. Endoscopy 2015; 47: 103-112
• 24 Hobel S, Dautel P, Baumbach R. et al. Single center experience of endoscopic submucosal dissection (ESD) in early Barrett’s adenocarcinoma. Surg Endosc 2015; 29: 1591-1597
• 25 Abe S, Ishihara R, Takahashi H. et al. Long-term outcomes of endoscopic resection and metachronous cancer after endoscopic resection for adenocarcinoma of the esophagogastric junction in Japan. Gastrointest Endosc 2019; 89: 1120-1128
• 26 Belghazi K, Pouw RE, Bergman JJ. In the expanding arena of endoscopic management for Barrett’s neoplasia, how should we fit in endoscopic submucosal dissection?. Gastrointest Endosc 2018; 87: 1394-1395
• 27 Berger A, Rahmi G, Perrod G. et al. Long-term follow-up after endoscopic resection for superficial esophageal squamous cell carcinoma: a multicenter Western study. Endoscopy 2019; 51: 298-306
• 28 Ell C, May A, Gossner L. et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 2000; 118: 670-677
• 29 Ell C, May A, Pech O. et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 2007; 65: 3-10
• 30 Codipilly DC, Dhaliwal L, Oberoi M. et al. Comparative outcomes of cap assisted endoscopic resection and endoscopic submucosal dissection in dysplastic Barrett’s esophagus. Clin Gastroenterol Hepatol 2020; DOI: 10.1016/j.cgh.2020.11.017.