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Complete EMR Effective, Durable for Treatment of BE-associated Neoplasia
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Complete endoscopic mucosal resection was a safe, effective and durable treatment for Barrett’s esophagus with high-grade dysplasia or neoplasia, according to recent study data.
Expanding on previous research reported in 2009, researchers evaluated the efficacy, safety, durability and diagnostic accuracy of endoscopic mucosal resection (EMR) on 107 patients referred to the Center for Endoscopic Research and Therapeutics at the University of Chicago for BE (mean length, 3.6 cm) with suspected high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) from 2003 to 2012. All patients underwent EMR and were followed up in 3- to 6-month intervals through January 2014 (mean follow-up, 40.6 months). They also received annual surveillance endoscopies for the first 5 years and every 2 years afterward.
Intention-to-treat analysis showed that EMR completely eradicated BE in 80.4% of patients, and per-protocol analysis showed 98.8% complete eradication. After EMR, diagnosis was upstaged for 25.2% of patients, four of whom (3.7% of total cohort) were initially diagnosed as HGD by biopsy and upstaged to submucosal carcinoma. Complications included: structures (41.1%) and symptomatic dysphagia (37.3%) with an average of 2.3 dilations required; perforations in two patients after EMR and in one after dilation; and HGD and IMC recurrence in one patient each, both of whom were treated successfully with EMR. Pathology analysis of the most recent specimens showed 71.6% of patients were in complete remission from intestinal metaplasia and 100% were in complete remission from HGD or cancer.
“This study shows that long-term eradication of BE and BE-related dysplasia/early neoplasia by means of widespread endoscopic resection is feasible,” Manol Jovani, MD, and Michael Wallace, MD, MPH, both from the division of gastroenterology and hepatology at the Mayo Clinic in Jacksonville, Fla., wrote in an accompanying editorial. “However, this approach is associated with a high rate of stricture formation, is more technically demanding, and does not appear to have higher efficacy than the hybrid approach. It appears that widespread mucosal resection will have a future only if it can be demonstrated that a subset of patients will benefit more from it than from the hybrid approach, and/or if stricture-preventing modalities will prove effective in significantly reducing stricture rates.”
For more information:
Jovani M. Clin Gastroenterol Hepatol. 2014;12:2011-2014.
Konda VJA. Clin Gastroenterol Hepatol. 2014;12:2002-2010.
Disclosure: The researchers report no relevant financial disclosures. Wallace reports receiving research funding from Boston Scientific, Cosmo Pharmaceuticals, Mayo Clinic, National Institutes of Health, NinePoint Medical and Olympus.