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Stepwise radical endoscopic resection for Barrett's esophagus with early neoplasia: report on a Brussels' cohort.
Endoscopy. 2008 Nov; 40(11):892-8.E

Abstract

BACKGROUND AND STUDY AIMS

The aim of this retrospective study was to assess safety and efficacy of stepwise radical endoscopic resection (SRER) in patients with Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or early cancer.

PATIENTS AND METHODS

Patients undergoing SRER between 2000 and 2006 were retrospectively evaluated. Patients with Barrett's esophagus who also had HGIN or early cancer were included if they had no signs of submucosal infiltration or metastases. SRER was performed using the cap-technique, at 8-week intervals until all Barrett's esophagus was removed. Follow-up endoscopy was scheduled every 6 months.

RESULTS

A total of 34 patients were included (31 male, mean 67 years, median Barrett's dimensions C1M4). HGIN / early cancer was eradicated in all patients in a median of two endoscopic resection sessions (IQR 1-2 sessions). Twelve patients underwent additional argon plasma coagulation for small islets or an irregular Z-line. Barrett's esophagus was eradicated in 28 patients (82 %). Complications occurred in 3/34 patients (9 %): two perforations, one delayed bleeding. In all, 19 patients (56 %) developed dysphagia, which was resolved with dilatation or stent placement. During a median follow-up period of 23 months (IQR 15 - 41 months), HGIN / early cancer recurred in three patients (9 %): two were retreated with endoscopic resection and one patient was referred for curative surgery. Five patients (15 %) had recurrence of nondysplastic Barrett's esophagus. At the end of the follow-up period all patients were free of HGIN / early cancer (one patient after surgery), and 23 patients (68 %) had complete endoscopic and histological eradication of Barrett's esophagus.

CONCLUSIONS

SRER resulted in complete eradication of HGIN/early cancer in all patients, and eradication of Barrett's esophagus in a majority of cases. A significant number of patients develop dysphagia, which can be successfully treated endoscopically.

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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19009481

Citation

Pouw, R E., et al. "Stepwise Radical Endoscopic Resection for Barrett's Esophagus With Early Neoplasia: Report On a Brussels' Cohort." Endoscopy, vol. 40, no. 11, 2008, pp. 892-8.
Pouw RE, Peters FP, Sempoux C, et al. Stepwise radical endoscopic resection for Barrett's esophagus with early neoplasia: report on a Brussels' cohort. Endoscopy. 2008;40(11):892-8.
Pouw, R. E., Peters, F. P., Sempoux, C., Piessevaux, H., & Deprez, P. H. (2008). Stepwise radical endoscopic resection for Barrett's esophagus with early neoplasia: report on a Brussels' cohort. Endoscopy, 40(11), 892-8. https://doi.org/10.1055/s-2008-1077675
Pouw RE, et al. Stepwise Radical Endoscopic Resection for Barrett's Esophagus With Early Neoplasia: Report On a Brussels' Cohort. Endoscopy. 2008;40(11):892-8. PubMed PMID: 19009481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stepwise radical endoscopic resection for Barrett's esophagus with early neoplasia: report on a Brussels' cohort. AU - Pouw,R E, AU - Peters,F P, AU - Sempoux,C, AU - Piessevaux,H, AU - Deprez,P H, Y1 - 2008/11/13/ PY - 2008/11/15/pubmed PY - 2009/3/20/medline PY - 2008/11/15/entrez SP - 892 EP - 8 JF - Endoscopy JO - Endoscopy VL - 40 IS - 11 N2 - BACKGROUND AND STUDY AIMS: The aim of this retrospective study was to assess safety and efficacy of stepwise radical endoscopic resection (SRER) in patients with Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or early cancer. PATIENTS AND METHODS: Patients undergoing SRER between 2000 and 2006 were retrospectively evaluated. Patients with Barrett's esophagus who also had HGIN or early cancer were included if they had no signs of submucosal infiltration or metastases. SRER was performed using the cap-technique, at 8-week intervals until all Barrett's esophagus was removed. Follow-up endoscopy was scheduled every 6 months. RESULTS: A total of 34 patients were included (31 male, mean 67 years, median Barrett's dimensions C1M4). HGIN / early cancer was eradicated in all patients in a median of two endoscopic resection sessions (IQR 1-2 sessions). Twelve patients underwent additional argon plasma coagulation for small islets or an irregular Z-line. Barrett's esophagus was eradicated in 28 patients (82 %). Complications occurred in 3/34 patients (9 %): two perforations, one delayed bleeding. In all, 19 patients (56 %) developed dysphagia, which was resolved with dilatation or stent placement. During a median follow-up period of 23 months (IQR 15 - 41 months), HGIN / early cancer recurred in three patients (9 %): two were retreated with endoscopic resection and one patient was referred for curative surgery. Five patients (15 %) had recurrence of nondysplastic Barrett's esophagus. At the end of the follow-up period all patients were free of HGIN / early cancer (one patient after surgery), and 23 patients (68 %) had complete endoscopic and histological eradication of Barrett's esophagus. CONCLUSIONS: SRER resulted in complete eradication of HGIN/early cancer in all patients, and eradication of Barrett's esophagus in a majority of cases. A significant number of patients develop dysphagia, which can be successfully treated endoscopically. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/19009481/Stepwise_radical_endoscopic_resection_for_Barrett's_esophagus_with_early_neoplasia:_report_on_a_Brussels'_cohort_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2008-1077675 DB - PRIME DP - Unbound Medicine ER -