Introduction Radical endoscopic ablation of Barrett’s epithelium performing 4–6 endoscopic resections during the same endoscopic session has been shown to result in complete Barrett’s ablation but has a high stricture rate (40–80%). Therefore radiofrequency ablation is preferred for the ablation of Barrett’s epithelium after endoscopic mucosal resection (EMR) of visible nodules.
We investigated whether non-radical, stepwise endoscopic mucosal resection with maximal 2 endoscopic resections per endoscopic session can result in complete remission of intestinal metaplasia and dysplasia in short segment Barrett’s oesophagus.
Methods We analysed our database of patients undergoing oesophageal EMR for early neoplasia in Barrett’s oesophagus from 2009 to 2014. Patients showing poorly differentiated cancer or advanced cancer (>T1sm2) after staging EMR were excluded. In patients suitable for further endoscopic therapy, EMR was performed using maximal two band ligation mucosectomies per endoscopic session; thereafter followup was 3 monthly and EMR was repeated as required for Barrett’s ablation. If no dysplasia was detected after a year, the follow up interval was increased to 6 months.
Results 118 patients underwent staging EMR for early Barrett’s neoplasia. Subsequently, 27 patients underwent surgery/chemotherapy due to deep submucosal or more advanced tumour stages or were managed conservatively depending on patient’s fitness, comorbidities and choice.
91 patients with HGD (48), intramucosal (38) or submucosal cancer (5) in the resected nodule underwent further endoscopic therapy with a mean follow-up of 24 months (8–36 months IQR). Remission of dysplasia/neoplasia was achieved in 94.5% after 12 months treatment.
Stepwise endoscopic Barrett’s resection resulted in complete Barrett’s ablation in 36 patients (39.6%) in a mean of 4 sessions. 40 patients (43.9%) had a short circumferential Barrett’s segment (C < 3 cm). In this group, repeated EMR achieved complete Barrett’s ablation in 85.0%. One patient developed a stricture (1.1%), one a delayed bleeding, there were no perforations.
Conclusion In patients with short Barrett’s segment, non-radical endoscopic Barrett’s resection at the time of scheduled endoscopy follow up allows complete Barrett’s ablation with very low stricture rate.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.