Endoscopic mucosal resection of Barrett's oesophagus containing dysplasia or intramucosal cancer

Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Postgraduate medical journal (Impact Factor: 1.45). 07/2007; 83(980):367-72. DOI: 10.1136/pgmj.2006.054841
Source: PubMed


Barrett's oesophagus is premalignant. Oesophagectomy is traditionally regarded as the standard treatment option in the presence of high grade intraepithelial neoplasia or intramucosal cancer. However, oesophagectomy is associated with high rates of mortality and morbidity. Endoscopic ablative therapies are limited by the lack of tissue for histological assessment, and the ablation may be incomplete. Endoscopic mucosal resection is an alternative to surgery in the management of high grade intraepithelial neoplasia and intramucosal cancer. It is less invasive than surgery and, unlike ablative treatments, provides tissue for histological assessment. This review will cover the indications, techniques and results of endoscopic mucosal resection.

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    • "Barrett's esophagus (BE) is a sequel of gastroesophageal reflux disease (GERD). Prevalence of BE in western countries is about 2% in general population and around 5–15% in chronic GERD patients [1] [2]. BE is a premalignant lesion that may progresses through stages of dysplasia to cancer, with esophageal adenocarcinoma (EAC) occurring at an overall incidence rate of 0.4–0.5% per year [3]. "
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    ABSTRACT: Background. Endoscopic surveillance for early detection of dysplastic or neoplastic changes in patients with Barrett's esophagus (BE) depends usually on biopsy. The diagnostic and therapeutic role of endoscopic mucosal resection (EMR) in BE is rapidly growing. Objective. The aim of this study was to check the accuracy of biopsy for precise histopathologic diagnosis of dysplasia and neoplasia, compared to EMR in patients having BE and related superficial esophageal lesions. Methods. A total of 48 patients with previously diagnosed BE (36 men, 12 women, mean age years) underwent routine surveillance endoscopic examination. Biopsies were taken from superficial lesions, if present, and otherwise from BE segments. Then, EMR was performed within three weeks. Results. Biopsy based histopathologic diagnoses were nondysplastic BE (NDBE), 22 cases; low-grade dysplasia (LGD), 14 cases; high-grade dysplasia (HGD), 8 cases; intramucosal carcinoma (IMC), two cases; and invasive adenocarcinoma (IAC), two cases. EMR based diagnosis differed from biopsy based diagnosis (either upgrading or downgrading) in 20 cases (41.67%), (Kappa , 95% CI: 0.170-0.69). Conclusions. Biopsy is not a satisfactory method for accurate diagnosis of dysplastic or neoplastic changes in BE patients with or without suspicious superficial lesions. EMR should therefore be the preferred diagnostic method in such patients.
    Full-text · Article · Jan 2015 · International Scholarly Research Notices
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    • "The results showed that lymph node metastasis was an important factor affecting the survival rate of patients with OC. Previous studies have shown that the risk for lymph node metastases was 0% for OC limited to the mucosal layer and 16–22% for OC that had invaded into the sub-mucosal layer [24]. The lymph node metastasis rate was reported to be 6% for T1a and 17.5% for T1b EC [25]. "
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    ABSTRACT: Transthoracic oesophagectomy is associated with high morbidity and mortality. Some oesophageal cancer (OC) patients with serious comorbidities cannot tolerate transthoracic oesophagectomy. Therefore, we have adopted a minimally invasive approach to oesophagectomy for such patients. Eighty-five OC patients, who could not tolerate transthoracic oesophagectomy, received mediastinoscopy-assisted oesophagectomy (MAO) from January 2007 to January 2010 in our hospital. Seventy patients were confirmed to be in T1 stage by postoperative pathological diagnosis, and their complications and outcomes were retrospectively analysed in this study. The impact of invasion depth, tumour length and lymph node metastases on the 5-year survival rate of these patients was also analysed. The operation time was 150.0 ± 15.0 min, and the perioperative bleeding volume was 202.0 ± 12.8 ml. Some patients had anastomotic leakage (5 cases), pneumonia (4 cases) and chylothorax (1 case). No patient died during hospitalization. The median postoperative hospital stay was 10 (7-22) days. The number of lymph nodes resected was 13.8 ± 4.4. The overall 5-year survival rate was 71%. Kaplan-Meier estimates revealed that tumour length (<2 vs ≥2 cm), lymph node metastasis (N0 vs N1) and depth of invasion (T1a vs T1b) could influence the 5-year survival rate (P<0.05). Multivariate analysis by Cox regression showed that lymph node metastasis and tumour length were independent prognostic factors for the 5-year survival rate (P <0.05). MAO could be performed for T1 OC patients with serious comorbidities who cannot tolerate transthoracic oesophagectomy. Lymph node metastasis and tumour length were independent prognostic factors for these patients. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Preview · Article · Dec 2014 · Interactive Cardiovascular and Thoracic Surgery
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    ABSTRACT: Actual Barrett's esophagus management includes symptomatic approach for GERD in order to prevent erosive injury, and endoscopic & histologycal surveillance to detect dysplasia and early cancer. In high-grade dysplasia and superficial carcinoma, less aggressive procedures has been attempted to avoid extended surgery, such as Argon Plasma Coagulator, Multipolar Coagulation, Heater Probe, Photodynamic Therapy, and recently radiofrequency local treatment, associated or not to antireflux surgery. Ultrasonic therapy and Cryotherapy are new approaches, which are under clinical investigation. Barrett's epithelium resection utilizing endoscopical mucosal resection is a new promising procedure, which comes to the arena, allowing besides the compromised epithelium removal, its complete pathological evaluation and probably a curative intent. The actual revision intents to discuss the results of the different alternatives at the platform of treatment in dysplastic Barrett's or early carcinoma growing in the Barrett's epithelium.
    Preview · Article · Jan 2007 · Acta gastroenterologica Latinoamericana
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