Original ArticlesEndoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett's esophagus☆,☆☆,★
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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Cited by (251)
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2021, Ultrasound in Medicine and BiologyRole of Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in the Management of Barrett's Related Neoplasia
2021, Gastrointestinal Endoscopy Clinics of North AmericaEndoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Endoscopic Therapy of Barrett's Esophagus-related Neoplasia
2015, Gastroenterology Clinics of North AmericaOne-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia
2014, Clinics and Research in Hepatology and Gastroenterology
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Supported by the Mayo Foundation and NIH grant CA72541.
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Reprint requests: Kenneth K. Wang, MD, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St., SW., Rochester, MN 55905.
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Gastrointest Endosc 2000;52:328–32.