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A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia
  1. Grischa Terheggen1,
  2. Eva Maria Horn2,
  3. Michael Vieth3,
  4. Helmut Gabbert4,
  5. Markus Enderle5,
  6. Alexander Neugebauer5,
  7. Brigitte Schumacher6,
  8. Horst Neuhaus2
  1. 1GastroPraxis Köln-Nord, Schwerpunktpraxis für Gastroenterologie und Hepatologie Köln, Cologne, Germany
  2. 2Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düssseldorf, Germany
  3. 3Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
  4. 4Institute of Pathology, University of Düsseldorf, Düssseldorf, Germany
  5. 5ERBE Elektromedizin GmbH, Tübingen, Germany
  6. 6Klinik für Innere Medizin und Gastroenterologie, Elisabeth Krankenhaus Essen, Essen, Germany
  1. Correspondence to Professor Horst Neuhaus, Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstrasse 40, Düsseldorf 40217, Germany; horst.neuhaus{at}evk-duesseldorf.de

Abstract

Background For endoscopic resection of early GI neoplasia, endoscopic submucosal dissection (ESD) achieves higher rates of complete resection (R0) than endoscopic mucosal resection (EMR). However, ESD is technically more difficult and evidence from randomised trial is missing.

Objective We compared the efficacy and safety of ESD and EMR in patients with neoplastic Barrett's oesophagus (BO).

Design BO patients with a focal lesion of high-grade intraepithelial neoplasia (HGIN) or early adenocarcinoma (EAC) ≤3 cm were randomised to either ESD or EMR. Primary outcome was R0 resection; secondary outcomes were complete remission from neoplasia, recurrences and adverse events (AEs).

Results There were no significant differences in patient and lesion characteristics between the groups randomised to ESD (n=20) or EMR (n=20). Histology of the resected specimen showed HGIN or EAC in all but six cases. Although R0 resection defined as margins free of HGIN/EAC was achieved more frequently with ESD (10/17 vs 2/17, p=0.01), there was no difference in complete remission from neoplasia at 3 months (ESD 15/16 vs EMR 16/17, p=1.0). During a mean follow-up period of 23.1±6.4 months, recurrent EAC was observed in one case in the ESD group. Elective surgery was performed in four and three cases after ESD and EMR, respectively (p=1.0). Two severe AEs were recorded for ESD and none for EMR (p=0.49).

Conclusions In terms of need for surgery, neoplasia remission and recurrence, ESD and EMR are both highly effective for endoscopic resection of early BO neoplasia. ESD achieves a higher R0 resection rate, but for most BO patients this bears little clinical relevance. ESD is, however, more time consuming and may cause severe AE.

Trial registration number NCT1871636

  • BARRETT'S OESOPHAGUS
  • ENDOSCOPIC PROCEDURES
  • ENDOSCOPY

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