Endoscopy 2011; 43(12): 1025-1032
DOI: 10.1055/s-0030-1257049
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Complete Barrett’s excision by stepwise endoscopic resection in short-segment disease: long term outcomes and predictors of stricture

A. Chung
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
M. J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
L. F. Hourigan
2   Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Australia
G. Lim
2   Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Australia
A. Moss
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
S. J. Williams
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
D. McLeod
3   Department of Anatomical Pathology, Westmead Hospital, Sydney, Australia
S. Fanning
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
V. Kariyawasam
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
K. Byth
4   University of Sydney, Westmead Campus, Sydney, Australia
› Author Affiliations
Further Information

Publication History

submitted28 January 2011

accepted after revision11 July 2011

Publication Date:
08 November 2011 (online)

Background and study aims: Complete Barrett’s excision (CBE) of short-segment Barrett’s high grade dysplasia (HGD) and early esophageal adenocarcinoma by stepwise endoscopic resection is a precise staging tool, detects covert synchronous disease, and may produce a sustained treatment response. Esophageal stricture is the most commonly reported complication of CBE although risk factors have not yet been clearly defined.

Patients and methods: Data were recorded prospectively on patients with limited co-morbidity and age ≤ 80 years undergoing CBE for histologically proven HGD or esophageal adenocarcinoma within ≤ C3M5 segments. Endoscopic resection was performed by standardized protocol every 6 – 8 weeks until CBE was achieved. Esophageal dilation was performed when patients reported dysphagia. Dysphagia scores were recorded at scheduled endoscopic surveillance or by telephone interview.

Results: By intention-to-treat analysis, complete eradication of neoplasia and intestinal metaplasia was achieved in 95 % and 82 %, respectively, in 77 patients undergoing a median of 2 resection sessions (interquartile range [IQR] 1 – 3). Esophageal dilation was required in 33 % (median 3 dilations, IQR 1 – 3.5) at median follow-up of 20 months (IQR 6 – 40). Independent risk factors for dilation requirement were the number of mucosal resections at the index procedure (odds ratio [OR] 1.3 per resection, 95 % confidence interval [CI] 1.0 – 1.9; P = 0.043) and maximal extent of the Barrett’s segment (OR 2.2 per cm, 95 %CI 1.2 – 3.9; P = 0.009).

Conclusions: Although CBE is highly effective in the treatment of Barrett’s HGD and esophageal adenocarcinoma, the risk of post-CBE dysphagia increases with the maximal extent of the Barrett’s segment and the number of mucosal resections at the index procedure. These data could be used to inform treatment decisions and identify those patients who may benefit from prophylactic therapies such as dilation.

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