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CC BY 4.0 · Endosc Int Open 2025; 13: a26028961
DOI: 10.1055/a-2602-8961
Original article

Endoscopic mucosal resection for Barrett’s neoplasia: Long-term outcomes from the largest Canadian single-center experience

Yusuke Fujiyoshi 
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
2   Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottowa Hospital Research Institute, Ottawa, ON, Canada (Ringgold ID: RIN6363)
,
Kareem Khalaf 
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Daniel Tham
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Mary Raina Angeli Fujiyoshi 
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
2   Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottowa Hospital Research Institute, Ottawa, ON, Canada (Ringgold ID: RIN6363)
,
Catherine J. Streutker
3   Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Natalia C. Calo 
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Jeffrey D. Mosko
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Gary R. May
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Norman E. Marcon
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Christopher W. Teshima
1   Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
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Abstract

Background and study aims

Endoscopic mucosal resection (EMR) remains an important treatment for high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE). However, there are limited data regarding long-term recurrence rates. This study aimed to investigate the neoplasia recurrence rate following EMR with long-term follow-up.

Methods

This was a retrospective cohort study at a tertiary-referral center in Canada. Patients with Barrett’s neoplasia (HGD/EAC) treated with EMR between January 2001 and December 2023 were included. The primary outcome was long-term neoplasia recurrence rate after complete remission of neoplasia (CRN). Secondary outcomes were residual/metachronous neoplasia rate at first follow-up, CRN rate, and long-term rate of patients successfully managed by endoscopy.

Results

A total of 552 patients (83.7% male, mean age 66.3 years) were included (HGD: 22.5%, EAC: 77.5%). After EMR, 475 patients were deemed to have had successful endoscopic resection (low lymph-node metastasis risk with tumor-free deep margin), 455 of whom underwent surveillance follow-up. At first follow-up, residual/metachronous neoplasia was observed in 20.9% (95/455), but 95.6% (435/455) eventually achieved CRN after undergoing a median of two EMR sessions (interquartile range: 1–4). As a primary outcome, the 5-year neoplasia recurrence rate was 10.5%, the 10-year rate was 21.6%, and the 15-year rate was 34.9%. During surveillance, neoplasia recurrence was observed in 38 patients, but 68.4% of them (26/38) were managed with endoscopic therapy. The overall rate of patients successfully managed by endoscopy was 93.0% (423/455).

Conclusions

While the success rate of EMR for BE is excellent, this study highlights substantial long-term risk of neoplastic recurrence, underscoring the need for indefinite surveillance for patients who had HGD or EAC.

Graphical abstract

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Endoscopic resection (ESD, EMRc, ...) - RFA and ablative methods

Supplementary Material



Publication History

Received: 04 October 2024

Accepted after revision: 24 March 2025

Article published online:
17 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Yusuke Fujiyoshi, Kareem Khalaf, Daniel Tham, Mary Raina Angeli Fujiyoshi, Catherine J. Streutker, Natalia C. Calo, Jeffrey D. Mosko, Gary R. May, Norman E. Marcon, Christopher W. Teshima. Endoscopic mucosal resection for Barrett’s neoplasia: Long-term outcomes from the largest Canadian single-center experience. Endosc Int Open 2025; 13: a26028961.
DOI: 10.1055/a-2602-8961
 

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