Introduction Endoscopic mucosal resection (EMR) is a minimally invasive therapeutic option for Barrett's dysplasia and early cancer. Prior to resection, it is important to delineate the extent of dysplasia and traditionally chromoscopy has been used. However multimodal image enhanced endoscopy could be useful to identify and delineate the dysplastic areas.
Methods The purpose of this study is to determine the efficacy and safety of multimodal imaging assisted EMR in Barrett's neoplasia in terms of curative resections. High-resolution endoscopy followed by autofluorescence imaging is used to detect the lesion and narrow band imaging with magnification is used to confirm early neoplasia. The area is marked under autofluorescence guidance to include all areas of dysplasia and EMR done using a multiband mucosectomy device (MBM) or EMR-cap.
Results 28 patients (21 males, mean age 68) were included in the analysis. The average length of Barrett's was 5.5 cm (range 1–13 cm). 21 patients had high-grade dysplasia (HGD) and seven patients had intramucosal cancer (IMC) in the pre-EMR biopsies. EMR was done using MBM in 23 patients and using EMR-cap in five patients. The histology was upgraded in 12 patients from HGD to IMC after EMR.
En-bloc resections were done in 10 patients and the rest had piecemeal resection. 3/4 patients who had incomplete deep resection margins underwent oesophagectomy. One of the specimens showed cancer, but the rest had only metaplasia. One patient did not undergo surgery due to comorbidities. Deep margins were clear in the rest 24 patients. Lateral margins were clear in 14/24 patients where it could be assessed histologically. Two patients had residual lesions in the lateral margins on follow-up endoscopy which were resected again. Thus 24/28 (86%) patients had a complete resection of the initial lesion by EMR. After a median follow-up of 16.5 months (IQR 8–25) and a mean number of two endoscopies (range 1–5) none of the 24 patients developed recurrence. Minor complications (bleeding) developed in three patients (10%) which were managed endoscopically.
Conclusion Multimodal imaging is useful in assisting EMR of Barrett's neoplasia by identifying and delineating the lesions and is an attractive alternative to chromoscopy.
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