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Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study.
Am J Gastroenterol. 2006 Jul; 101(7):1449-57.AJ

Abstract

OBJECTIVES

Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving rapidly. Aim of this study was to prospectively evaluate safety and efficacy of stepwise radical endoscopic resection (ER) of BE containing early neoplasia.

METHODS

Patients with early neoplasia (i.e., high-grade intraepithelial neoplasia or early cancer) in BE < or = 5 cm, without signs of submucosal infiltration or lymph node/distant metastases, were included. Patients underwent resection sessions (cap technique after submucosal lifting) with intervals of 6 wk.

RESULTS

Between January 2003 and December 2004, 39 consecutive patients were included. Therapy was discontinued in two patients due to unrelated comorbidity. Complete eradication of early neoplasia was achieved in all 37 treated patients in a median number of three sessions. Complete removal of all Barrett's mucosa was achieved in 33 (89%) patients: 4 patients (all had undergone APC [argon plasma coagulation]) were found to have small isles of Barrett's mucosa underneath neosquamous mucosa. Complications occurred in two out of 88 (2%) ER procedures: one asymptomatic perforation, one delayed bleeding. Symptomatic stenosis occurred in 10 of 39 (26%) patients and was effectively treated by endoscopic bougienage. During a median follow-up of 11 months, no patients died and none had recurrence of neoplasia or Barrett's mucosa.

CONCLUSIONS

Stepwise radical ER is effective for selected patients with early neoplasia in BE; provides optimal histopathological diagnosis; and may reduce recurrence rate, since all mucosa at risk is effectively removed. Use of APC should be limited to prevent buried Barrett's mucosa. Methods for prevention of stenosis should be developed.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16863545

Citation

Peters, Femke P., et al. "Stepwise Radical Endoscopic Resection Is Effective for Complete Removal of Barrett's Esophagus With Early Neoplasia: a Prospective Study." The American Journal of Gastroenterology, vol. 101, no. 7, 2006, pp. 1449-57.
Peters FP, Kara MA, Rosmolen WD, et al. Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study. Am J Gastroenterol. 2006;101(7):1449-57.
Peters, F. P., Kara, M. A., Rosmolen, W. D., ten Kate, F. J., Krishnadath, K. K., van Lanschot, J. J., Fockens, P., & Bergman, J. J. (2006). Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study. The American Journal of Gastroenterology, 101(7), 1449-57.
Peters FP, et al. Stepwise Radical Endoscopic Resection Is Effective for Complete Removal of Barrett's Esophagus With Early Neoplasia: a Prospective Study. Am J Gastroenterol. 2006;101(7):1449-57. PubMed PMID: 16863545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study. AU - Peters,Femke P, AU - Kara,Mohammed A, AU - Rosmolen,Wilda D, AU - ten Kate,Fiebo J W, AU - Krishnadath,Kausilia K, AU - van Lanschot,J Jan B, AU - Fockens,Paul, AU - Bergman,Jacques J G H M, PY - 2006/7/26/pubmed PY - 2006/9/1/medline PY - 2006/7/26/entrez SP - 1449 EP - 57 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 101 IS - 7 N2 - OBJECTIVES: Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving rapidly. Aim of this study was to prospectively evaluate safety and efficacy of stepwise radical endoscopic resection (ER) of BE containing early neoplasia. METHODS: Patients with early neoplasia (i.e., high-grade intraepithelial neoplasia or early cancer) in BE < or = 5 cm, without signs of submucosal infiltration or lymph node/distant metastases, were included. Patients underwent resection sessions (cap technique after submucosal lifting) with intervals of 6 wk. RESULTS: Between January 2003 and December 2004, 39 consecutive patients were included. Therapy was discontinued in two patients due to unrelated comorbidity. Complete eradication of early neoplasia was achieved in all 37 treated patients in a median number of three sessions. Complete removal of all Barrett's mucosa was achieved in 33 (89%) patients: 4 patients (all had undergone APC [argon plasma coagulation]) were found to have small isles of Barrett's mucosa underneath neosquamous mucosa. Complications occurred in two out of 88 (2%) ER procedures: one asymptomatic perforation, one delayed bleeding. Symptomatic stenosis occurred in 10 of 39 (26%) patients and was effectively treated by endoscopic bougienage. During a median follow-up of 11 months, no patients died and none had recurrence of neoplasia or Barrett's mucosa. CONCLUSIONS: Stepwise radical ER is effective for selected patients with early neoplasia in BE; provides optimal histopathological diagnosis; and may reduce recurrence rate, since all mucosa at risk is effectively removed. Use of APC should be limited to prevent buried Barrett's mucosa. Methods for prevention of stenosis should be developed. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16863545/Stepwise_radical_endoscopic_resection_is_effective_for_complete_removal_of_Barrett's_esophagus_with_early_neoplasia:_a_prospective_study_ L2 - http://Insights.ovid.com/pubmed?pmid=16863545 DB - PRIME DP - Unbound Medicine ER -