Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study.
Endoscopy
; 54(5): 439-446, 2022 05.
Article
em En
| MEDLINE
| ID: mdl-34450667
ABSTRACT
BACKGROUND:
The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia.METHODS:
We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan-Meier curve was used to compare the groups.RESULTS:
243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43â% vs. 89â%; Pâ<â0.001) and R0 (56â% vs. 73â%; Pâ=â0.01) rates than ESD. There was no difference in the rates of perforation (0.7â% vs. 0; Pâ>â0.99), early bleeding (0.7â% vs. 1â%; Pâ>â0.99), delayed bleeding (3.3â% vs. 2.1â%; Pâ=â0.71), and stricture (10â% vs. 16â%; Pâ=â0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4â% [44/140] for EMR and 3.5â% [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75-30) and 8 (2-18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2â% vs. ESD 3.5â%; Pâ<â0.001).CONCLUSIONS:
ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Esôfago de Barrett
/
Neoplasias Esofágicas
/
Adenocarcinoma
/
Ressecção Endoscópica de Mucosa
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article