Introduction our objectives were to demonstrate endoscopic mucosal resection’s (emr) efficacy in removing early neoplasia within bo and its usefulness in obtaining comprehensive histological specimens to accurately stage the early neoplasia and effectively deliver therapy.
Method we have conducted a retrospective analysis using our electronic database for endoscopic procedures for patients with bo who underwent emr from october 2010 to december 2016. we analysed the resection margins for both en bloc and piecemeal emrs. we compared the histology from the referral endoscopy to the histology obtained from the emr to analyse any deviation. we also investigated the three-year survival in patients and the causes of death.
Results a total of 99 patients underwent 134 emr endoscopic procedures and 259 emrs, the male/female ratio was 84%, the mean age at first emr was 71 (sd=8.2). the median length of the circumferential and maximum extent of the bo segments were 3 and 4 cm respectively (iqr 2–4).44 patients underwent 60 en bloc resections, of which 34 (56.7%) had clear deep and radial resection margins. 14 (23.3%) were involved at the radial margin. 2 (3.3%) were involved at the deep margin and 8 (13.4%) were involved at both margins. 2 (3.3%) were clear at the deep margin, but due to thermal damage the radial margins were indeterminate. of the 44 patients 37 (84.1%) had no visible residual early neoplasia on the follow up endoscopy.55 patients underwent 74 piecemeal emrs, of which 52 (70.3%) had clear deep margins. 38 (51.4%) had no residual neoplasia on the follow up endoscopy. pre emr biopsy histology showed high grade dysplasia (hgd) in 49 (59.8%) patients, mucosal adenocarcinoma in 24 (29.2%) and low grade dysplasia in 9 (11%). however the emr histology resulted in altered grading in 59 (72%) patients, with 47 (57%) upstaged and 12 (14%) down staged. the emr histology showed hgd in 16 (19.5%) patients, intramucosal adenocarcinoma in 33 (40.2%), submucosal adenocarcinoma in 20 (24.4%) and lgd in 13 (15.9%). the remaining 42 emrs were performed for visible lesions within bo without pre emr histology result, predominately for patients in rfa program. the 3 year survival rate for 42 patients, in that time period included 8 deaths, 5 due to cardiac failure, 1 due to a pe, 2 due to advanced oesophageal adenocarcinoma.
conclusion in this moderately sized retrospective study emr has been proven to be an effective diagnostic and therpaeutic tool in managing early neoplasia within bo.
Disclosure of interest none declared
- barrett’s oesophagus
- early cancer
- endoscopic mucosal resection (emr)