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Long-term follow-up of complete Barrett's eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma.
Endoscopy. 2007 Dec; 39(12):1086-91.E

Abstract

BACKGROUND AND STUDY AIMS

In patients with Barrett's esophagus (BE), targeted endoscopic mucosal resection (EMR) of visible lesions of high grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) is effective, but carries the risk of leaving in place synchronous lesions and Barrett's epithelium with the potential for recurrent disease. We evaluated the safety and long-term efficacy of complete Barrett's eradication EMR (CBE-EMR) for the treatment of patients with HGD or IMC, independently of the presence of macroscopically visible lesions or surgical risk.

PATIENTS AND METHODS

26 consecutive patients with BE and HGD or IMC underwent CBE-EMRs, which were performed with the endoscopic cap suction method and/or a 2.3-mm monofilament mucosectomy snare. Endoscopic follow up after completion of resection was carried out to assess the rate of residual or recurrent BE with or without HGD or IMC.

RESULTS

24 patients completed the study. They underwent a total of 44 EMR sessions with a median of 3 pieces (range 1-8) removed per session. Two patients with immediate bleeding were successfully managed endoscopically. Three patients developed an early esophageal stricture that was completely resolved with a single endoscopic dilation. After a median follow-up of 28 months (range 15-51 months), persistent endoscopic and histologic eradication of BE was demonstrated in 21 patients (87.5 %). In two patients, Barrett's epithelium was detected beneath the neosquamous epithelium 3 months after completion of the resection. In the remaining patient, IMC was found in a nodule seen and removed by EMR at 12-month surveillance endoscopy.

CONCLUSIONS

CBE-EMR is a safe and highly effective long-term treatment that should be offered to all patients with Barrett's esophagus with HGD and IMC.

Authors+Show Affiliations

Section of Endoscopy and Therapeutics and the Cancer Research Center, The University of Chicago, Chicago, Illinois 60637, USA.No affiliation info availableNo affiliation info availableNo 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

17701854

Citation

Larghi, A, et al. "Long-term Follow-up of Complete Barrett's Eradication Endoscopic Mucosal Resection (CBE-EMR) for the Treatment of High Grade Dysplasia and Intramucosal Carcinoma." Endoscopy, vol. 39, no. 12, 2007, pp. 1086-91.
Larghi A, Lightdale CJ, Ross AS, et al. Long-term follow-up of complete Barrett's eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy. 2007;39(12):1086-91.
Larghi, A., Lightdale, C. J., Ross, A. S., Fedi, P., Hart, J., Rotterdam, H., Noffsinger, A., Memeo, L., Bhagat, G., & Waxman, I. (2007). Long-term follow-up of complete Barrett's eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy, 39(12), 1086-91.
Larghi A, et al. Long-term Follow-up of Complete Barrett's Eradication Endoscopic Mucosal Resection (CBE-EMR) for the Treatment of High Grade Dysplasia and Intramucosal Carcinoma. Endoscopy. 2007;39(12):1086-91. PubMed PMID: 17701854.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term follow-up of complete Barrett's eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. AU - Larghi,A, AU - Lightdale,C J, AU - Ross,A S, AU - Fedi,P, AU - Hart,J, AU - Rotterdam,H, AU - Noffsinger,A, AU - Memeo,L, AU - Bhagat,G, AU - Waxman,I, Y1 - 2007/08/15/ PY - 2007/8/19/pubmed PY - 2008/1/29/medline PY - 2007/8/19/entrez SP - 1086 EP - 91 JF - Endoscopy JO - Endoscopy VL - 39 IS - 12 N2 - BACKGROUND AND STUDY AIMS: In patients with Barrett's esophagus (BE), targeted endoscopic mucosal resection (EMR) of visible lesions of high grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) is effective, but carries the risk of leaving in place synchronous lesions and Barrett's epithelium with the potential for recurrent disease. We evaluated the safety and long-term efficacy of complete Barrett's eradication EMR (CBE-EMR) for the treatment of patients with HGD or IMC, independently of the presence of macroscopically visible lesions or surgical risk. PATIENTS AND METHODS: 26 consecutive patients with BE and HGD or IMC underwent CBE-EMRs, which were performed with the endoscopic cap suction method and/or a 2.3-mm monofilament mucosectomy snare. Endoscopic follow up after completion of resection was carried out to assess the rate of residual or recurrent BE with or without HGD or IMC. RESULTS: 24 patients completed the study. They underwent a total of 44 EMR sessions with a median of 3 pieces (range 1-8) removed per session. Two patients with immediate bleeding were successfully managed endoscopically. Three patients developed an early esophageal stricture that was completely resolved with a single endoscopic dilation. After a median follow-up of 28 months (range 15-51 months), persistent endoscopic and histologic eradication of BE was demonstrated in 21 patients (87.5 %). In two patients, Barrett's epithelium was detected beneath the neosquamous epithelium 3 months after completion of the resection. In the remaining patient, IMC was found in a nodule seen and removed by EMR at 12-month surveillance endoscopy. CONCLUSIONS: CBE-EMR is a safe and highly effective long-term treatment that should be offered to all patients with Barrett's esophagus with HGD and IMC. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/17701854/Long_term_follow_up_of_complete_Barrett's_eradication_endoscopic_mucosal_resection__CBE_EMR__for_the_treatment_of_high_grade_dysplasia_and_intramucosal_carcinoma_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-966788 DB - PRIME DP - Unbound Medicine ER -