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Complications from endoscopic mucosal resection uncommon in Barrett’s esophagus
Patients with Barrett’s esophagus experienced no perforations and low rates of bleeding and strictures when treated with endoscopic mucosal resection in a recent study.
Researchers evaluated 681 patients with Barrett’s esophagus (BE) who underwent 1,388 endoscopic procedures and 2,513 endoscopic mucosal resections (EMRs) at Mayo Clinic in Rochester, Minn., between January 1995 and August 2008, with a median follow-up of 63 months. Photodynamic therapy (PDT) also was performed in 211 cases.
Participants’ mean age was 70 years, and they had a median BE length of 3 cm. A single endoscopist performed 99% of the included EMRs, using the cap and snare technique in 77% of procedures, band and snare in 18% and a variceal band ligation device in 5%.
“EMR is an accepted technique for the diagnosis and treatment of dysplastic lesions in BE,” the researchers wrote. “However, the published data regarding EMR-related complications are highly variable and limited to small series. … To our knowledge, our study is the largest series reported to date on the complications of EMR in BE.”
No perforations related to EMR occurred. Post-EMR bleeding was observed in eight patients, none of whom received PDT. Seven of these cases were treated endoscopically, with one patient requiring surgery. Strictures after EMR occurred in seven cases; all treated via a mean of two endoscopic dilations. No participants who developed strictures had also undergone PDT.
Univariate analysis indicated no significant associations between bleeding or strictures and age, BE length, previous therapies or the number of EMRs received.
“In this retrospective study, EMR for BE was associated with a low rate of complications for selected patients when performed by experienced hands, which partially justifies the use of this technique as a diagnostic procedure,” the researchers concluded.