Comparison of EMR and ESD for early Barrett's neoplasia: A Systematic Review and Meta-Analysis

Aims Barrett's esophagus (BE) with visible lesions including high-grade dysplasia and esophageal adenocarcinoma is treated by endoscopic resection. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both accepted strategies for resection of Barrett’s lesions. However, a lack of consensus exists regarding which technique offers superior clinical outcomes and safety. This study aims to compare the clinical outcomes and safety of EMR versus ESD in treating early Barrett's neoplasia and esophageal adenocarcinoma.

Methods We searched 3 databases (Embase, MEDLINE, Cochrane Central) until October 1st, 2023. We included studies aimed at assessing the efficacy of EMR and ESD as treatment modalities for BE and esophageal adenocarcinoma. Our inclusive criteria encompassed randomized trials as well as observational studies. We focused on key outcome measures, namely, en bloc, R0 and curative resection rates, recurrence rates and adverse events rates. We performed meta-analyses on reported rates for en bloc, R0 and curative resection, and recurrence. Effect sizes were expressed as pooled Odds Ratio (OR) and 95% Confidence Intervals (CI) for resection and recurrence rates, and 95% Confidence Intervals (CI).

Results Our search identified 905 records. We excluded 181 duplicates, screened 22 full texts and 724 abstracts from the total search. 15 studies were included in the final analyses. Data pooled from 11 studies showed significantly higher en bloc resection rates [OR=1.846 (95% CI: 1.567-2.125), 11 studies] with ESD. R0 resection rates from 10 studies were significantly higher with ESD [OR=1.58, (95% CI: 0.955-2.21), 10 studies]. Curative resection rates from 5 studies were significantly higher with ESD [OR=1.173 (95% CI: 0.066 – 2.280), 5 studies]. The local recurrence rates pooled from 10 studies were significantly higher with EMR [OR=0.941 (95% CI: 0.129-1.753), 10 studies].

Conclusions In a systematic review of studies comparing EMR and ESD for early Barrett's neoplasia, ESD achieves higher en bloc, R0 and curative resection rates, while EMR is associated with higher local recurrence rates. These results suggest that ESD may be a more effective option for managing early Barrett's neoplasia. [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]

PROSPERO: (CRD42023426486)

Conflicts of interest

All the authors have no relevant financial disclosures or conflicts of interest to declare.CWT – Speaker: Medtronic and Boston Scientific, Consultant: Boston Scientific. SCG –Research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, Sanofi, and BioJAMP, education grants from Janssen, and has equity in Volo Healthcare.

• References

• 1 Sanaka MR, Parikh MP, Muthukuru S, Raja S, Murthy S, Ahmad U. et al. Tu1166 Outcomes of endoscopic submucosal dissection (esd) and endoscopic mucosal resection (emr) in early esophageal adenocarcinoma associated with barrett’s esophagus. Gastrointestinal Endoscopy 2018; 87 06: AB551
• 2 Chedgy F, Subramaniam S, Kandiah K, Thayalasekaran S, Bhandari P.. Tu1155 EMR vs ESD for Barrett’s Neoplasia: Time to shift the paradigm?. Gastrointestinal Endoscopy 2016; 83 05: AB556-7
• 3 Vantanasiri K, Joseph A, Sachdeva K, Goyal R, Garg N, Codipilly D. et al. Rates of recurrent intestinal metaplasia and dysplasia after successful endoscopic therapy of barrett’s neoplasia by cap assisted emr vs esd and ablation: results from a large north american mulicenter cohort. Gastrointestinal Endoscopy 2023; 97 06: AB976-7
• 4 Young A, Bahdi F, Li F, Mehta N, Robertson S, Chahal P. et al. Mo1226 The effect of endoscopic mucosal resection (emr) vs endoscopic submucosal dissection (esd) technique on histologic margins for endoscopically treated early esophageal adenocarcinoma. Gastrointestinal Endoscopy 2019; 89 06: AB473-4
• 5 Golger D.. Esd versus emr in esophageal adenocarcinoma (EAC)-report of a german center. United European Gastroenterology Journal 2015; 3 5_suppl: 1-145
• 6 Mejia Perez LK, Yang D, Draganov PV, Jawaid S, Chak A, Dumot J. et al. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett’s neoplasia in the West: a retrospective study. Endoscopy. 2022; 54 05: 439-46
• 7 Doumbe-Mandengue P, Pellat A, Belle A, Ali EA, Hallit R, Beuvon F. et al. Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal adenocarcinoma. Clinics and Research in Hepatology and Gastroenterology 2023; 47 (06) 102138
• 8 Podboy A, Kolahi KS, Friedland S, Louie CY.. Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett’s-related neoplasia. Digestive Endoscopy 2020; 32 (03) 346-54
• 9 Meinhardt C.. Efficacy, recurrence and complication rates of endoscopic mucosal resection versus endoscopic submucosal dissection for early barrett’s neoplasia: A retrospective german single center analysis. United European Gastroenterology Journal 2016; 4 5_suppl: A157-720
• 10 Pilonis N.. Defining the optimal treatment approach for early neoplasia of the gastroesophageal junction: A multi-center retrospective study. UEG Journal 2020; 8 S8: 144-887
• 11 Codipilly DC, Dhaliwal L, Oberoi M, Gandhi P, Johnson ML, Lansing RM. et al. Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus. Clin Gastroenterol Hepatol 2022; 20 (01) 65-73.e1
• 12 Younis F.. Clinical stratification for endoscopic submucosal dissection versus endoscopic mucosal resection for Barrett’s associated neoplasia: long-term follow-up. UEG Journal 2022; 10 S8: 9-184
• 13 Terheggen G, Horn EM, Vieth M, Gabbert H, Enderle M, Neugebauer A. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 2017; 66 (05) 783-93

Publication History

Article published online:
15 April 2024