Introduction Oesophageal adenocarcinoma carries a poor prognosis and therefore treatment of early neoplasia arising in the precursor condition Barrett’s Oesophagus (BE) is desirable. Visible lesions arising in BE need endoscopic mucosal resection (EMR) for accurate staging and removal. Resection modalities include a cap based system with snare and custom made multiband mucosectomy (MBM) devices (Duette, Cook Medical Ltd). A new MBM device has been launched (Captivator, Boston Scientific Ltd). Aim: A retrospective study to compare the efficacy, safety, specimen size and histology of EMR specimens resected with two MBM devices (Cook Duette and Boston Captivator) in treatment naïve patients undergoing endoscopic therapy for BE neoplasia.
Method All procedures were carried out by a single experienced endoscopist in a single unit. All visible lesions were marked and resected using 1 of the 2 MBM devices. Identical diathermy settings and suction pressures were used and all lesions were resected without submucosal injection. All samples were fixed to cork by the same endoscopy nurses. All resected specimens were analysed by the same two experienced pathologists. The resected specimens in both groups were analysed for length mm (max diameter), width mm (min diameter) and surface area SA mm2.
Results This study included 20 patients [18M+2F; mean age=74 (range:53–85)] in the Duette group and 19 [16M+3F; mean age=72(range:48–87) in the captivator group with a mean max length of BE of 5.7 cm (Range:0–15) and 5.4 cm (Range:1–15) respectively (P=NS). Successful resection in 100% of the cases with a total of 58 specimens resected in the duette and 61 in the captivator group. There were no reported perforations. There was 1 delayed bleeds in both groups requiring endoscopic therapy (P=NS). First follow up endoscopy showed 2 strictures post EMR in the duette group and 1 in the captivator. Fifty percent of the cancer cases in the duette group showed SM invasion, in comparion to 21% in the Captivator (P=NS). Lengthm, width and surface area of Captivator EMRs were larger than the Duette (surface area 135 vs 114mm2, p=0.005).
Conclusion Both MBM devices are safe and effective at resecting visible lesions in patients with BE neoplasia.The EMR Captivator device appears to resects specimens with a larger surface area in the oesophagus when compared with the Duette device. A possible advantage of this is in situations where en bloc resection is wanted for larger lesions (>10 mm) and where fewer resections per lesion size is desirable in larger lesions. A further randomised trial would be needed to confirm these findings.
Disclosure of Interest None Declared
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