Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett's neoplasia.
Endoscopy
; 47(2): 103-12, 2015 Feb.
Article
em En
| MEDLINE
| ID: mdl-25412090
ABSTRACT
BACKGROUND AND STUDY AIMS:
The role of endoscopic submucosal dissection (ESD) in Barrett's neoplasia is ill-defined, although it might provide a higher curative resection rate and better histologic assessment than endoscopic mucosal resection (EMR). We aimed to assess efficacy, safety, and long-term results of ESD. PATIENTS ANDMETHODS:
A retrospective analysis was done of 75 consecutive patients with Barrett's esophagus who underwent ESD between January 2007 and February 2014.âESD was performed for visible lesions that were multiple, larger than 15âmm, or poorly lifting, or suspected of submucosal infiltration. The primary end point was the rate of curative resection of carcinoma.RESULTS:
Median patient age was 68 years (interquartile range [IQR] 61â-â76), median follow-up was 20 months (IQR 8.5â-â37.5), and median maximum specimen diameter was 52.5âmm (IQR 43â-â71). En bloc resection rate was 90â% (66â/73), and rates of curative resection of carcinoma and high grade dysplasia/carcinoma were 85â% (47â/55) and 64â% (42â/66), respectively. G3 differentiation and invasion to greater than pT1m2 were observed in 25â% (14â/55) and 67â% (37â/55) of patients with adenocarcinoma, respectively. There were 5 early (â<â48 hours) adverse events (2 delayed hemorrhages and 3 perforations), all treated endoscopically. No ESD-specific death occurred. Esophageal strictures developed in 60â% of patients, all treated endoscopically. Additional treatment (median sessions 2 [IQR 2â-â3]) for residual Barrett's esophagus were recommended to 62â% (42â/68). At latest follow-up, complete remission of neoplasia and intestinal metaplasia was found in 92â% (54â/59) and 73â% (43â/59) of patients, respectively.CONCLUSION:
ESD appears to be safe and effective, with a high rate of curative resection of carcinoma. ESD should be considered for patients with Barrett's neoplasia at risk of incomplete resection or poor pathologic assessment with conventional EMR.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Esôfago de Barrett
/
Neoplasias Esofágicas
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Adenocarcinoma
/
Esofagoscopia
/
Dissecação
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article