Introduction Radical endoscopic ablation of Barrett’s epithelium performing 4–6 endoscopic resections during the same endoscopic session has been shown to result in complete Barrett’s ablation but has a high stricture rate (48–88%).^1–3 Therefore radiofrequency ablation is preferred for the ablation of Barrett’s epithelium after endoscopic mucosal resection (EMR) of visible nodules.

We investigated whether non-radical, stepwise endoscopic mucosal resection with maximal 2 endoscopic resections per endoscopic session also resulted in complete remission of Barrett’s epithelium.

Methods We analysed our database of patients undergoing oesophageal EMR for early neoplasia in Barrett’s oesophagus from 2008 to 2013. Patients undergoing surgery or palliative therapy after staging EMR showing poorly differentiated cancer or advanced cancer (>T1sm) were excluded. In patients suitable for further endoscopic therapy, EMR was performed using maximal two band ligation mucosectomies per endoscopic session. Patients were endoscopically followed up 3 monthly and EMR was repeated as required for Barrett’s ablation. If no dysplasia was detected after a year, the follow up interval was increased to 6 months. Only patients with circumferential Barrett’s length of more than 5 cm underwent radiofrequency ablation.

Results 83 patients underwent staging EMR for early Barrett’s neoplasia. Subsequently, 25 patients underwent surgery/chemotherapy due to submucosal or more advanced tumour stages or were managed conservatively depending on patient’s fitness, comorbidities and choice. 58 patients with HGD (21), intramucosal (22) or submucosal cancer (5) in the resected nodule underwent further endoscopic therapy with a mean follow-up of 24 months (8–36 months IQR). Remission of dysplasia/neoplasia was achieved in 96.5%. Stepwise endoscopic Barrett’s resection resulted in complete Barrett’s ablation in 28 patients (48.3%) in a median of 4 sessions (IQR 2–5). 31 patients (53.4%) had a short Barrett’s segment (<3 cm). In this group, repeated EMR achieved complete Barrett’s ablation in 87%. Only two patients developed a stricture (3.4%), there were no perforations.

Conclusion Stepwise, non-radical endoscopic Barrett’s resection at the time of scheduled endoscopy follow up allows complete Barrett’s ablation with very low stricture rate in patients with short Barrett’s segment.

References

1. van Vilsteren FG, Pouw RE, Seewald S et al. Gut 2011;60:765–73

2. Alvarez Herrero L, Pouw RE, van Vilsteren FG et al. Endoscopy 2011;43:177–83

3. Pouw RE, Seewald S, Gondrie JJ et al. Gut 2010;59:1169–77

Disclosure of Interest None Declared.