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

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.

Publication History

Received: 04 April 2024

Accepted after revision: 15 July 2024

Article published online:
03 September 2024

• References

• 1 de Jonge PJF, van Blankenstein M, Looman CWN. et al. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut 2010; 59: 1030-1036
• 2 Yousef F, Cardwell C, Cantwell MM. et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett’s esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008; 168: 237-249 DOI: 10.1093/aje/kwn121. (PMID: 18550563)
• 3 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111: 30-51 DOI: 10.1038/ajg.2015.322. (PMID: 26526079)
• 4 Weusten BLAM, Bisschops R, Dinis-Ribeiro M. et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2023; 55: 1124-1146
• 5 Forbes N, Elhanafi SE, Al-Haddad MA. et al. American Society for Gastrointestinal Endoscopy guideline on endoscopic submucosal dissection for the management of early esophageal and gastric cancers: summary and recommendations. Gastrointest Endosc 2023; 98: 271-284 DOI: 10.1016/j.gie.2023.03.015. (PMID: 37498266)
• 6 von Elm E, Altman DG, Egger M. et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349
• 7 Vieth M, Stolte M. Pathology of early upper GI cancers. Best Pract Res Clin Gastroenterol 2005; 19: 857-869 DOI: 10.1016/j.bpg.2005.02.008. (PMID: 16338646)
• 8 Stolte M, Kirtil T, Oellig F. et al. The pattern of invasion of early carcinomas in Barrett’s esophagus is dependent on the depth of infiltration. Pathol Res Pract 2010; 206: 300-304 DOI: 10.1016/j.prp.2010.01.005. (PMID: 20188488)
• 9 Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1998; 93: 1028-1032 DOI: 10.1111/j.1572-0241.1998.00362.x. (PMID: 9672324)
• 10 Kobayashi R, Calo NC, Marcon N. et al. Predictors of recurrence of dysplasia or cancer in patients with dysplastic Barrett’s esophagus following complete eradication of dysplasia: a single-center retrospective cohort study. Surg Endosc 2022; 36: 5041-5048 DOI: 10.1007/s00464-021-08864-6. (PMID: 34750708)
• 11 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 DOI: 10.1136/gutjnl-2015-310126. (PMID: 26801885)
• 12 Mejia Perez LK, Yang D, Draganov PV. et al. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett’s neoplasia in the West: a retrospective study. Endoscopy 2022; 54: 439-446
• 13 Doumbe-Mandengue P, Pellat A, Belle A. et al. Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma. Clin Res Hepatol Gastroenterol 2023; 47: 102138 DOI: 10.1016/j.clinre.2023.102138. (PMID: 37169124)
• 14 Fujiyoshi Y, Khalaf K, He T. et al. Comparison of endoscopic mucosal resection versus endoscopic submucosal dissection for Barrett’s neoplasia and esophageal adenocarcinoma: a systematic review and meta-analysis. Gastrointest Endosc 2024; 2024 DOI: 10.1016/j.gie.2024.06.012. (PMID: 38879048)