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Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett's esophagus.
Surg Endosc 2016; 30(12):5330-5337SE

Abstract

BACKGROUND AND AIMS

Piecemeal endoscopic mucosal resection (EMR) is the standard treatment of nodular Barrett's esophagus dysplasia and T1a cancer. Piecemeal resection may be incomplete and makes precise histologic assessment difficult. Endoscopic submucosal dissection (ESD) is a technique that enables en-bloc resection but has not gained widespread acceptance due to its technical difficulty, risk and long procedure time.

METHODS

We developed a protocol consisting of a combination of a limited ESD with supplementary EMR in the same session if necessary, designed to increase en-bloc resection of the most worrisome neoplastic area while maximizing the rate of complete resection of dysplasia. Records of consecutive patients referred for treatment during a 2-year period were reviewed.

RESULTS

Eleven patients were treated: two with ESD and nine with combined ESD/EMR. Eight patients had mucosal lesions; three patients had submucosally invasive cancer and were referred to surgery. Five of the 8 mucosal lesions were removed en-bloc by ESD with dysplasia-free margins. Two patients with T1a cancer had low-grade dysplasia in the ESD margins and removal of all dysplasia on EMR. One patient with T1a cancer had high-grade dysplasia in the ESD margins and on EMR. He required a second endoscopy to remove residual neoplasia. There were no adverse events. The mean procedure time was 66.4 ± 15.1 min.

CONCLUSIONS

Combining a limited ESD with EMR in the same session enables efficient treatment of visible dysplastic lesions in Barrett's esophagus.

Authors+Show Affiliations

Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.Department of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA. shai_friedland@yahoo.com. VA Palo Alto Health Care System, 711 Middlefield Road, Palo Alto, CA, 94301, USA. shai_friedland@yahoo.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27071930

Citation

Holmes, Ian, et al. "Combining Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection to Treat Neoplasia in Barrett's Esophagus." Surgical Endoscopy, vol. 30, no. 12, 2016, pp. 5330-5337.
Holmes I, Hing T, Friedland S. Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett's esophagus. Surg Endosc. 2016;30(12):5330-5337.
Holmes, I., Hing, T., & Friedland, S. (2016). Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett's esophagus. Surgical Endoscopy, 30(12), pp. 5330-5337.
Holmes I, Hing T, Friedland S. Combining Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection to Treat Neoplasia in Barrett's Esophagus. Surg Endosc. 2016;30(12):5330-5337. PubMed PMID: 27071930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett's esophagus. AU - Holmes,Ian, AU - Hing,Tressia, AU - Friedland,Shai, Y1 - 2016/04/12/ PY - 2016/01/16/received PY - 2016/03/21/accepted PY - 2016/4/14/pubmed PY - 2017/8/8/medline PY - 2016/4/14/entrez KW - Barrett esophagus KW - Endoscopic mucosal resection KW - Endoscopic submucosal dissection KW - Esophagus cancer SP - 5330 EP - 5337 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 12 N2 - BACKGROUND AND AIMS: Piecemeal endoscopic mucosal resection (EMR) is the standard treatment of nodular Barrett's esophagus dysplasia and T1a cancer. Piecemeal resection may be incomplete and makes precise histologic assessment difficult. Endoscopic submucosal dissection (ESD) is a technique that enables en-bloc resection but has not gained widespread acceptance due to its technical difficulty, risk and long procedure time. METHODS: We developed a protocol consisting of a combination of a limited ESD with supplementary EMR in the same session if necessary, designed to increase en-bloc resection of the most worrisome neoplastic area while maximizing the rate of complete resection of dysplasia. Records of consecutive patients referred for treatment during a 2-year period were reviewed. RESULTS: Eleven patients were treated: two with ESD and nine with combined ESD/EMR. Eight patients had mucosal lesions; three patients had submucosally invasive cancer and were referred to surgery. Five of the 8 mucosal lesions were removed en-bloc by ESD with dysplasia-free margins. Two patients with T1a cancer had low-grade dysplasia in the ESD margins and removal of all dysplasia on EMR. One patient with T1a cancer had high-grade dysplasia in the ESD margins and on EMR. He required a second endoscopy to remove residual neoplasia. There were no adverse events. The mean procedure time was 66.4 ± 15.1 min. CONCLUSIONS: Combining a limited ESD with EMR in the same session enables efficient treatment of visible dysplastic lesions in Barrett's esophagus. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/27071930/Combining_endoscopic_submucosal_dissection_and_endoscopic_mucosal_resection_to_treat_neoplasia_in_Barrett's_esophagus_ L2 - https://dx.doi.org/10.1007/s00464-016-4885-y DB - PRIME DP - Unbound Medicine ER -