Elsevier

Gastrointestinal Endoscopy

Volume 52, Issue 3, September 2000, Pages 328-332
Gastrointestinal Endoscopy

Original Articles
Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett's esophagus,☆☆,

https://doi.org/10.1067/mge.2000.105777Get rights and content

Abstract

Background: Endoscopic mucosal resection has been used in the treatment of superficial squamous cell cancers and gastric malignancies. Our aim was to determine whether endoscopic mucosal resection can be used in the diagnosis of lesions within Barrett's esophagus whose endoscopic appearances raise suspicion of carcinoma or high-grade dysplasia. Methods: Twenty-five patients with such lesions within Barrett's esophagus underwent endoscopic mucosal resection for diagnostic and therapeutic purposes. All patients underwent endoscopic ultrasound to determine the feasibility of endoscopic resection. Only lesions found to be uT0 or uT1 underwent EMR. The lift and cut technique was used in 23 patients and a variceal ligating device was used on 2 patients. Results: Endoscopic mucosal resection was performed because of a nodule or polyp within Barrett's esophagus in 11 patients (44%) and suspected superficial cancer or high-grade dysplasia in 14 patients (56%). Endoscopic mucosal resection diagnosed superficial adenocarcinoma in 13 patients (52%) and high-grade dysplasia in 4 (16%); it confirmed lesions in 8 patients (40%) to be of lower neoplastic risk. No complications occurred due to the procedure itself. Conclusions: Endoscopic mucosal resection is a technique with low morbidity and mortality. It has led to a change in diagnosis in patients with Barrett's esophagus and lesions with endoscopic features that suggest neoplasia. Its major advantages include simplicity and retrieval of the specimen en bloc. (Gastrointest Endosc 2000;52:328–32.)

Section snippets

Patients and methods

EMR was performed on 25 consecutive patients referred for evaluation of Barrett's esophagus with focal lesions between 1995 and 1998. Informed consent was obtained from all patients. These lesions were regions of ulcerated, polypoid, or nodular mucosa within a Barrett's segment that had been identified at prior examinations and which resulted in the referral of the patient for further evaluation and therapy. An estimation of the size of the lesion was made endoscopically by comparison with an

Results

Twenty-five patients underwent EMR (21 men, 4 women; average age 67 ± 7 years, range 16 to 83; Table 1).EMR was performed because of a nodule or polyp within Barrett's esophagus in 11 patients (44%) or because of endoscopic features that raised a suspicion of superficial cancer or high-grade dysplasia in 14 patients (56%). The latter included areas endoscopically recognizable by the presence of mucosa that was irregular, friable, ulcerated, or villous appearing.

Histopathologic evaluation

Discussion

EMR can be performed using a lift-and-cut technique through a double-channel endoscope or with a standard endoscope and the variceal band ligator. Both techniques involve injection of an epinephrine solution into the submucosa to separate the lesion from the underlying muscle layer. This helps to shield the muscularis propria from damage and confirm the superficial nature of the lesion. Inability to elevate the lesion indicates deeper invasion and increased risk if EMR is attempted. The muscle

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Supported by the Mayo Foundation and NIH grant CA72541.

☆☆

Reprint requests: Kenneth K. Wang, MD, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St., SW., Rochester, MN 55905.

Gastrointest Endosc 2000;52:328–32.

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