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Endoscopy 2025; 57(01): 5-13
DOI: 10.1055/a-2382-5891
Original article

Recurrence following successful eradication of neoplasia with endoscopic mucosal resection compared with endoscopic submucosal dissection in Barrett’s esophagus: a retrospective comparison

Yusuke Fujiyoshi 
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
2   Department of Medicine, Division of Gastroenterology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
,
Kareem Khalaf 
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Daniel Tham
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Mary Raina Angeli Fujiyoshi 
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
2   Department of Medicine, Division of Gastroenterology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
,
Natalia C. Calo 
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Jeffrey D. Mosko
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Gary R. May
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
,
Christopher W. Teshima
1   Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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Comparing recurrence rates between endoscopic mucosal resection and endoscopic submucosal dissection in Barrett’s endoscopic therapy: timing and definitions matter!Endoscopy 2025; 57(01): 14-16
DOI: 10.1055/a-2427-7128

Abstract

Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective treatments for Barrett’s neoplasia. However, little is known about recurrence rates following these techniques. We compared long-term neoplasia recurrence rates following EMR and ESD.

Methods This study included patients with Barrett’s neoplasia (high grade dysplasia/adenocarcinoma) treated between July 2019 and December 2023 at a tertiary referral center in Canada. Outcomes were residual neoplasia at first follow-up, complete remission of neoplasia (CRN), and neoplasia recurrence following CRN.

Results 157 patients were included (87 EMR, 70 ESD). Compared with EMR, the ESD group had larger lesions (median 2 vs. 3 cm, P<0.05), more adenocarcinoma (85.1% vs. 94.3%, P = 0.07), and deeper submucosal invasion (T1a: 71.6% vs. 75.8%; T1b-SM1: 25.7% vs. 6.1%; T1b≥SM2: 2.7% vs. 18.2%; P<0.05). Among 124 patients with follow-up (71 EMR, 53 ESD), 84.9% of ESD-treated patients had curative resections (i.e. R0 resection with low risk for lymph node metastasis), whereas 94.4% of EMR-treated patients had deep margin R0 resection of low risk lesions. At first follow-up, residual neoplasia (14.1% vs. 11.3%) and CRN (97.2% vs. 100%) were similar in the EMR and ESD groups, but neoplasia recurrence following CRN was significantly higher with EMR (13% vs. 1.9%, P<0.05), with cumulative probability of recurrence at 3 years of 18.3% vs. 4.2%, respectively.

Conclusions Neoplasia recurrence following CRN was significantly higher following EMR compared with ESD, suggesting that ESD may be superior to EMR in preventing neoplasia recurrence in Barrett’s esophagus.

Supplementary Material



Publication History

Received: 04 April 2024

Accepted after revision: 15 July 2024

Article published online:
03 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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