Introduction Endoscopic mucosal resection (EMR) is a widely used technique for the management of early neoplasia withi Barrett’s oesophagus (BO). EMR is believed to be a safe procedure. However the published data regarding EMR-related complications are variable and the expertise of those performing EMR is often not disclosed. Our aim was to determine the complication rates of EMR in our patients at a tertiary referral centre in the UK.
Method We have conducted a retrospective analysis using our electronic database for endoscopic procedures for patients with BO who underwent EMR from October 2010 to December 2016. EMR was performed by an endoscopist, expert in EMR and an endoscopist, training in EMR, in patients with neoplastic appearing lesions. Bleeding, strictures, and perforation related to EMR were reviewed as the main outcome measurements. The complication rates for the expert and trainee in EMR were analysed and compared. The complication rates were also analysed in relation to the size of the EMR.
Results A total of 99 patients underwent 134 EMR procedures and 259 EMRs, the male/female ratio was 84%, the mean age at first EMR was 71 (SD=8.2). 24 patients underwent 2 EMR procedures, 2 patients underwent 3 EMR procedures and 2 patients underwent 4 EMR procedures. The median length of the circumferential and maximum extent of the BO segments were 3 and 4 cm respectively (interquartile range (IQR) 2–4). Complication rates for procedures were as followed: 30 day mortality post EMR was 0% (0 cases). Within 8 day hospitalisation post EMR was 5.9% (8 cases). Bleeding during the EMR procedure was 11.9% (16 cases). Bleeding post procedure with a hospital admission and blood transfusion was 0.7% (1 case). Post EMR stricture was 9.7% (13 cases) of which 4.4% (6 cases) required dilatation. There was endoscopic evidence of perforation in 1.5% (2 cases). Both patients were treated during the procedure; in both cases a CT scan with non-ionic contrast swallow excluded perforation. There was no statistically significant difference in the number of minor complication for the trainee and the expert. Most importantly there was no significant, life threatening complication in either group. The complication rates increase with the size of the EMR.
Conclusion In this moderately sized retrospective study, EMR for early neoplasia within BO was shown to be a relatively safe procedure with low complication rates. A tertiary referral centre with these numbers of EMR procedures may be a safe environment for training in EMR. Any arising complications, during or post procedure, were dealt with effectively.
Disclosure of Interest None Declared
- Barretts Oesophagus
- Endoscopic Mucosal Resection
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