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Endoscopic submucosal dissection lowers recurrence rates in Barrett’s early neoplasia
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SAN ANTONIO — Treatment with endoscopic submucosal dissection helped lower recurrence rates and reduce the need for repeat treatment in patients with Barrett’s esophagus-associated early neoplasia, according to study results presented at the American College of Gastroenterology Annual Meeting.
Lady Katherine Mejia Perez, MD, of Cleveland Clinic Foundation, said that while en bloc resection and R0 resection are associated with recurrence rates in gastric cancer and other conditions, their role in Barrett’s-related neoplasia are unclear.
“Most patients who undergo [endoscopic mucosal resection (EMR)] will initially have radiofrequency ablation, which takes care of the low-grade dysplasia and in the long-term would reduce the rate of recurrence,” she said during her presentation. “Secondly, Barrett’s-related neoplasia has a very low incidence in Japan, which is where most of the literature on ESD comes from.”
Researchers performed a retrospective study of 241 patients who underwent ESD (n = 84) or EMR (n = 154) for BE-associated high-grade dysplasia or T1a esophageal adenocarcinoma at six academic centers. The primary outcome of the study was a composite of metastasis and local recurrence rate. Researchers also sought to identify predictors of recurrence.
Compared with EMR, ESD achieved higher rates of en bloc resection (96% vs. 33%; P < .0001), R0 resection (76% vs. 54%; P = .0009) and curative resection (75% vs. 32%; P < .0001). It also had a lower 24-month local recurrence rate (43% vs. 11%; P = .0007).
Perez and colleagues found that en bloc resection was one of the critical factors in limiting recurrence, because piecemeal resection was associated with recurrence in multivariate analysis (HR = 5.4; 95% CI, 2.3-15.5).
“ESD compared to EMR is able to result in more definitive treatment of Barrett’s esophagus-associated early dysplasia,” Perez said. “It has significantly lower recurrence rates, which translates to decreased need for repeat endoscopic therapeutic procedures.” – by Alex Young
Reference:
Perez LKM, et al. Abstract 35. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosures: Perez reports no relevant financial disclosures. Please see the study abstract for all other authors’ relevant financial disclosures.