Introduction The risks of ESD in the oesophagus are perceived to be high and consequences potentially disastrous. For this reason, EMR is the most common technique to resect early Barrett’s cancer. However, the drawback of EMR is piecemeal resection with difficulties interpreting resection margins of cancers. The aim of this study was to evaluate feasibility, safety, and outcomes of ESD in the endoscopic treatment of Barrett’s neoplasia and to compare these with EMR.
Methods All data was collected prospectively on a predesigned electronic database between 2006 and 2015. The database was interrogated by independent researchers blinded to the endoscopic procedures. Bleeding was defined as significant if patients required transfusion, endoscopic therapy or hospitalisation. Strictures were defined as significant if they were symptomatic or requiring dilatation. SPSS was used for statistical analysis of data
Results 81 oesophageal ESDs were performed in 70 patients and 180 EMRs were performed in 112 patients during the study period. Table 1 demonstrates patient and lesion characteristics and outcomes following resection including deep R0 resection margin for cancer and histological outcomes. Lesion morphology and histology was significantly more advanced in the ESD group as compared to EMR.
The endoscopic cure rate in the EMR group was 81% with 19% of patients upstaged requiring radical treatment. In the ESD group the endoscopic cure rate was 87% with 13% of patients upstaged requiring radical treatment.
Conclusion This is the biggest reported comparison of EMR vs ESD for Barrett’s neoplasia. Proportionately more Is and IIC lesions were resected by ESD than by EMR which is reflected by significantly more cancers identified in the ESD group. Our data shows the safety and efficacy for ESD resection of Barrett’s cancers but EMR still remains a standard therapeutic option for non-cancerous Barrett’s neoplasia. This calls for a prospective RCT comparing ESD vs EMR for Barrett’s cancer.
Disclosure of Interest None Declared
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