Curative endoscopic therapy for Barrett's early cancer and high grade dysplasia: long-term results in 304 patients

Aims: Endoscopic resection (ER) has gained more and more importance in the treatment of early neoplasia in Barrett's esophagus. As long as there has been no long-term follow-up of endoscopic treatment radical esophageal resection was regarded as the gold standard for treatment in high-grade dysplasia (HGD) and early Barrett's carcinoma (BC). We report on the first five-year follow-up data for endoscopic therapy (ET) in a large series.

Patients: A total of 304 patients (mean age 67.2±11.1 years) with HGD (n=45) and early adenocarcinoma (n=259) in Barrett's esophagus were included between 10/96–09/01.

Methods: The efficacy in treating HGD/BC by ET was examined in the framework of a prospective study. ER was performed in 215 patients with a total of 605 resections (2.8 ER/patient), and photodynamic therapy (PDT) with 5-aminolevulinic acid was used in 72 patients. Both procedures were combined in 12 patients. Five patients underwent primary treatment with argon plasma coagulation (APC). The mean follow-up was 69.5±10 months (range 48–108 months).

Results: Complete remission was achieved in 262 patients 86%. During follow-up, metachronous lesions/recurrences were observed in 64 patients (24%); ET was performed successfully in all but 5 (1.6%) of these patients, who underwent surgery because the histological examination of the resected specimen showed an infiltration of blood or lymph vessels respectively a deep infiltration of the submucosal layer (>sm1). 34 patients have died so far, but only 2 patients (0.66%) due to Barrett's neoplasia, the remaining 32 patients died from concomitant disease. The 5-year survival rate was 89%. Overall complication rate was 15.1%. Major bleeding after ER (drop of haemoglobin >2g/dl) occurred in 4 patients, but no perforation was observed. Minor complications were not Hb relevant bleeding (n=29) and stenosis (n=10) after ER, long-lasting odynophagia (n=1) and sunburn (n=2) after PDT.

Conclusions: This is the largest series with a long-term follow-up for ET of HGD/BC. The excellent 5-year-survival rates and the low mortality and complication rates of ET, especially compared with surgical therapy, makes ET to the first choice of treatment in patients with HGD and BC.