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Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients.
Endoscopy. 2004 Sep; 36(9):782-7.E

Abstract

BACKGROUND AND STUDY AIMS

Treatment by endoscopic mucosal resection (EMR) has been established for early lesions in Barrett's esophagus. However, the remaining Barrett's esophagus epithelium remains at risk of developing further lesions. The aim of this study was to evaluate the efficacy of circumferential endoscopic mucosectomy (circumferential EMR)s in removing not only the index lesion (high-grade intraepithelial neoplasia (HGIN) or mucosal cancer), but also the remaining Barrett's esophagus epithelium.

PATIENTS AND METHODS

A total of 21 patients were included in the study (11 men, 10 women), who had Barrett's esophagus and either HGIN (n = 12) or mucosal cancer (n = 9). Of the patients, 17/21 were at high surgical risk and five had refused surgery. On the basis of preprocedure endosonography their lesions were classified as T1N0 (n = 19) or T0N0 (n = 2). The lesions and the Barrett's esophagus epithelium were removed by polypectomy after submucosal injection of 10-15 ml of saline; a double-channel endoscope was used in 15/21 cases. Circumferential EMR was performed in two sessions, the lesion and the surrounding half of the circumferential Barrett's esophagus mucosa being removed in the first session. In order to prevent the formation of esophageal stenosis, the second half of the Barrett's esophagus mucosa was resected 1 month later.

RESULTS

Complications occurred in 4/21 patients (19 %), consisting of bleeding which was successfully managed by endoscopic hemostasis in all cases. No strictures were observed during follow-up (mean duration 18 months) and endoscopic resection was considered complete in 18/21 patients (86 %). For three patients, histological examination showed incomplete removal of tumor: one of these underwent surgery; two received chemoradiotherapy, and showed no evidence of residual tumor at 18 months' and 24 months' follow-up, respectively. Two patients in whom resection was initially classified as complete later presented with local recurrence and were treated again by EMR. Barrett's esophagus mucosa was completely replaced by squamous cell epithelium in 15/20 patients (75 %).

CONCLUSIONS

Circumferential EMR is a noninvasive treatment of Barrett's esophagus with HGIN or mucosal cancer, with a low complication rate and good short-term clinical efficacy. Further studies should focus on long-term results and on technical improvements.

Authors+Show Affiliations

Endoscopic Unit, Institut Paoli-Calmettes, 232 Boulevard St-Marguerite, 13273 Marseilles Cedex 9, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15326573

Citation

Giovannini, M, et al. "Circumferential Endoscopic Mucosal Resection in Barrett's Esophagus With High-grade Intraepithelial Neoplasia or Mucosal Cancer. Preliminary Results in 21 Patients." Endoscopy, vol. 36, no. 9, 2004, pp. 782-7.
Giovannini M, Bories E, Pesenti C, et al. Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. Endoscopy. 2004;36(9):782-7.
Giovannini, M., Bories, E., Pesenti, C., Moutardier, V., Monges, G., Danisi, C., Lelong, B., & Delpero, J. R. (2004). Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. Endoscopy, 36(9), 782-7.
Giovannini M, et al. Circumferential Endoscopic Mucosal Resection in Barrett's Esophagus With High-grade Intraepithelial Neoplasia or Mucosal Cancer. Preliminary Results in 21 Patients. Endoscopy. 2004;36(9):782-7. PubMed PMID: 15326573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients. AU - Giovannini,M, AU - Bories,E, AU - Pesenti,C, AU - Moutardier,V, AU - Monges,G, AU - Danisi,C, AU - Lelong,B, AU - Delpero,J R, PY - 2004/8/25/pubmed PY - 2005/1/8/medline PY - 2004/8/25/entrez SP - 782 EP - 7 JF - Endoscopy JO - Endoscopy VL - 36 IS - 9 N2 - BACKGROUND AND STUDY AIMS: Treatment by endoscopic mucosal resection (EMR) has been established for early lesions in Barrett's esophagus. However, the remaining Barrett's esophagus epithelium remains at risk of developing further lesions. The aim of this study was to evaluate the efficacy of circumferential endoscopic mucosectomy (circumferential EMR)s in removing not only the index lesion (high-grade intraepithelial neoplasia (HGIN) or mucosal cancer), but also the remaining Barrett's esophagus epithelium. PATIENTS AND METHODS: A total of 21 patients were included in the study (11 men, 10 women), who had Barrett's esophagus and either HGIN (n = 12) or mucosal cancer (n = 9). Of the patients, 17/21 were at high surgical risk and five had refused surgery. On the basis of preprocedure endosonography their lesions were classified as T1N0 (n = 19) or T0N0 (n = 2). The lesions and the Barrett's esophagus epithelium were removed by polypectomy after submucosal injection of 10-15 ml of saline; a double-channel endoscope was used in 15/21 cases. Circumferential EMR was performed in two sessions, the lesion and the surrounding half of the circumferential Barrett's esophagus mucosa being removed in the first session. In order to prevent the formation of esophageal stenosis, the second half of the Barrett's esophagus mucosa was resected 1 month later. RESULTS: Complications occurred in 4/21 patients (19 %), consisting of bleeding which was successfully managed by endoscopic hemostasis in all cases. No strictures were observed during follow-up (mean duration 18 months) and endoscopic resection was considered complete in 18/21 patients (86 %). For three patients, histological examination showed incomplete removal of tumor: one of these underwent surgery; two received chemoradiotherapy, and showed no evidence of residual tumor at 18 months' and 24 months' follow-up, respectively. Two patients in whom resection was initially classified as complete later presented with local recurrence and were treated again by EMR. Barrett's esophagus mucosa was completely replaced by squamous cell epithelium in 15/20 patients (75 %). CONCLUSIONS: Circumferential EMR is a noninvasive treatment of Barrett's esophagus with HGIN or mucosal cancer, with a low complication rate and good short-term clinical efficacy. Further studies should focus on long-term results and on technical improvements. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/15326573/Circumferential_endoscopic_mucosal_resection_in_Barrett's_esophagus_with_high_grade_intraepithelial_neoplasia_or_mucosal_cancer__Preliminary_results_in_21_patients_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-825813 DB - PRIME DP - Unbound Medicine ER -