Introduction Endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is now considered standard for treatment of high grade dysplasia (HGD) and intramucosal cancer in Barrett’s oesophagus (BE). Complete ablation of the Barrett’s epithelium is recommended to reduce the risk of metachronous neoplasia. However, RFA is an expensive treatment modality, often requiring repeat procedures and endoscopic surveillance thereafter and may not be necessary in all patients.
Methods We analysed our database of oesophageal EMR procedures performed for HGD or early cancer from 2008 to 2012. Patients’ demographics, Barrett’s length, histology, number of procedures, remission and complication were assessed. All patients referred for endoscopic treatment of early Barrett’s neoplasia were investigated using EUS to exclude obvious infiltration of deeper structures. EMR was performed using band ligation mucosectomy. Patients were followed up 3 monthly with endoscopy and EMR repeated as required. If no dysplasia was found after a year, follow up interval was increased to 6 months.
Results 64 patients underwent EMR for HGD (20) or early oesophageal cancer (44) in BE. 149 EMR’s were performed. 48 patients were male (75%), mean age was 70.6years (range 30–87years). 20 patients (31%) with either submucosal or deeper infiltration or poor differentiation in the EMR specimen underwent surgery/chemotherapy or were conservatively managed depending on patient’s fitness, comorbidities and choice. Mean follow-up of the remaining 44 patients undergoing endoscopic therapy was 22.7 month (range 1–55 months). Remission of dysplasia/neoplasia was achieved in 97.9%. Stepwise EMR during follow up resulted in complete ablation of BE in 18 patients (40%) in a mean of 4 sessions. All patients with complete endoscopic Barrett’s ablation had an initial maximal Barrett lengths < 3 cm. 7 patients with long Barrett’s ( > 5cm) received RFA and 7 others are awaiting the procedure. The overall complication rate was low (6.7%) including a stricture after RFA (0.7%), 8 procedural (5.3%, none Hb relevant) and a delayed bleeding (0.7%) but no perforations. All complications were managed endoscopically.
Conclusion Oesophageal EMR is a safe procedure which can achieve remission of neoplasia. In short segment Barrett’s oesophagus it can also result in complete ablation of BE. Stepwise endoscopic resection for ablation has a low complication rate when performed in 3 monthly follow-up intervals.
Disclosure of Interest None Declared
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