CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(05): E727-E734
DOI: 10.1055/a-1386-3668
Original article

Wide-field endoscopic submucosal dissection for the treatment of Barrett’s esophagus neoplasia

Masami Omae
1   Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
Hannes Hagström
1   Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
2   Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
Nelson Ndegwa
1   Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
3   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Michael Vieth
4   Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
Naining Wang
5   Department of Pathology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
Miroslav Vujasinovic
1   Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
Francisco Baldaque-Silva
1   Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
› Author Affiliations


Background and study aims Implementation of endoscopic submucosal dissection (ESD) for the treatment of Barrett’s esophagus neoplasia (BEN) has been hampered by high rates of positive margins and complications. Dissection with wider margins was proposed to overcome these problems, but was never tested. We aim to compare Wide-Field ESD (WF-ESD) with conventional ESD (C-ESD) for treatment of BEN.

Patients and methods This was a cohort study of all ESDs performed in our center during 2011 to 2018. C-ESD was the only technique used before 2014, with WF-ESD used beginning in 2014. In WF-ESD marking was performed 10 mm from the tumor margin compared to 5 mm with C-E.

Results ESD was performed in 90 cases, corresponding to 74 patients, 84 % male, median age 69. Of these, 22 were C-ESD (24 %) and 68 were WF-ESD (76 %). The en bloc resection rate was 95 vs 100 % (ns), the positive lateral margin rate was 23 % vs 3 % (P  < 0.01), the R0 rate was 73 % vs 90 %, and the curative resection rate was 59 % vs 76 % in the C-ESD and WF-ESD groups, respectively, (both P > 0.05). The procedure speed was 4.4 and 2.3 (min/mm) in the C-ESD and WF-ESD groups (P < 0.01), respectively. WF-ESD was associated with less post-operative strictures, 6 % vs 27 % (P = 0.01), with no local recurrence but no significantly reduced risk of metachronous recurrence (Hazard Ratio = 0.46, 95 %CI = 0.14–1.46), during a follow-up of 13.4 and 9.4 months in the C-ESD and WF-ESD cohorts, respectively.

Conclusions WF-ESD is associated with a reduction in positive lateral margins, faster dissection, and lower stricture rates. Further prospective, multicenter studies are warranted to evaluate its role in clinical practice.

Publication History

Received: 25 April 2020

Accepted: 20 January 2021

Article published online:
22 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 de Jonge PJ, van Blankenstein M, Grady WM. et al. Barrettʼs oesophagus: epidemiology, cancer risk and implications for management. Gut 2014; 63: 191-202
  • 2 Pech O, May A, Manner H. et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660.e1
  • 3 Pech O, Behrens A, May A. et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrettʼs oesophagus. Gut 2008; 57: 1200-1206
  • 4 Ell C, May A, Gossner L. et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrettʼs esophagus. Gastroenterology 2000; 118: 670-677
  • 5 Bulsiewicz WJ, Kim HP, Dellon ES. et al. Safety and efficacy of endoscopic mucosal therapy with radiofrequency ablation for patients with neoplastic Barrettʼs esophagus. Clin Gastroenterol Hepatol 2013; 11: 636-642
  • 6 Qumseya BJ, Wani S, Desai M. et al. Adverse events after radiofrequency ablation in patients with Barrettʼs esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 1086-1095.e6
  • 7 Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrettʼs esophagus: a systematic review. Am J Gastroenterol 2011; 106: 1899-1908 quiz 1909
  • 8 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
  • 9 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrettʼs neoplasia. Gut 2017; 66: 783-793
  • 10 Siddiki H, Fukami N. Endoscopic submucosal dissection for Barrettʼs neoplasia: decade of experience, little progress. Is ESD thE-BEST for complex Barrettʼs neoplasia?. Gastrointest Endosc 2017; 86: 619-622
  • 11 Silva FB, Dinis-Ribeiro M, Vieth M. et al. Endoscopic assessment and grading of Barrettʼs esophagus using magnification endoscopy and narrow-band imaging: accuracy and interobserver agreement of different classification systems (with videos). Gastrointest Endosc 2011; 73: 7-14
  • 12 Swager AF, Curvers WL, Bergman JJ. Diagnosis by endoscopy and advanced imaging of Barrettʼs Neoplasia. Adv Exp Med Biol 2016; 908: 81-98
  • 13 Baldaque-Silva F, Marques M, Andrade AP. et al. Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis. United European Gastroenterol J 2019; 7: 326-334
  • 14 Holt BA, Bourke MJ. Wide field endoscopic resection for advanced colonic mucosal neoplasia: current status and future directions. Clin Gastroenterol Hepatol 2012; 10: 969-979
  • 15 Subramaniam S, Chedgy F, Longcroft-Wheaton G. et al. Complex early Barrettʼs neoplasia at 3 Western centers: European Barrettʼs Endoscopic Submucosal Dissection Trial (E-BEST). Gastrointest Endosc 2017; 86: 608-618
  • 16 Neuhaus H, Terheggen G, Rutz EM. et al. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrettʼs esophagus. Endoscopy 2012; 44: 1105-1113
  • 17 Yamaguchi N, Isomoto H, Nakayama T. et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
  • 18 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
  • 19 Shaheen NJ, Overholt BF, Sampliner RE. et al. Durability of radiofrequency ablation in Barrettʼs esophagus with dysplasia. Gastroenterology 2011; 141: 460-468
  • 20 Altorki NK, Lee PC, Liss Y. et al. Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg 2008; 247: 434-439
  • 21 Sato H, Inoue H, Kobayashi Y. et al. Control of severe strictures after circumferential endoscopic submucosal dissection for esophageal carcinoma: oral steroid therapy with balloon dilation or balloon dilation alone. Gastrointest Endosc 2013; 78: 250-257
  • 22 Babyak MA. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 2004; 66: 411-421
  • 23 Shaheen NJ, Falk GW, Iyer PG. et al. American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Barrettʼs Esophagus. Am J Gastroenterol 2016; 111: 30-50 quiz 51
  • 24 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrettʼs esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
  • 25 Phoa KN, Pouw RE, Bisschops R. et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2016; 65: 555-562
  • 26 Komeda Y, Bruno M, Koch A. EMR is not inferior to ESD for early Barrettʼs and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates. Endosc Int Open 2014; 2: E58-E64
  • 27 Probst A, Aust D, Märkl B. et al. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2015; 47: 113-121
  • 28 Yang D, Coman RM, Kahaleh M. et al. Endoscopic submucosal dissection for Barrettʼs early neoplasia: a multicenter study in the United States. Gastrointest Endosc 2017; 86: 600-607
  • 29 Goa KL, Benfield P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs 1994; 47: 536-566
  • 30 Coman RM, Gotoda T, Forsmark CE. et al. Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrettʼs esophagus: a Western center experience. Endosc Int Open 2016; 4: E715-E721
  • 31 Chung A, Bourke MJ, Hourigan LF. et al. Complete Barrettʼs excision by stepwise endoscopic resection in short-segment disease: long term outcomes and predictors of stricture. Endoscopy 2011; 43: 1025-1032
  • 32 Chevaux JB, Piessevaux H, Jouret-Mourin A. et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrettʼs neoplasia. Endoscopy 2015; 47: 103-112