Endoscopy 2019; 51(04): S79
DOI: 10.1055/s-0039-1681402
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ESD esophagus Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR BARRETT'S ESOPHAGUS LARGE OR FIBROTIC VISIBLE LESIONS: A BICENTRIC WESTERN COUNTRY PROSPECTIVELY COLLECTED EXPERIENCE

AM Bucalau
1   Erasme University Hospital ULB, Brussels, Belgium
,
A Lemmers
1   Erasme University Hospital ULB, Brussels, Belgium
,
N Sidhu
2   Westmead University Hospital, Sydney, Australia
,
P Eisendrath
3   St Peter University Hospital, Brussels, Belgium
,
J Deviere
1   Erasme University Hospital ULB, Brussels, Belgium
,
M Bourke
2   Westmead University Hospital, Sydney, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Some suspected submucosal or fibrotic Barrett esophagus (BE) lesions, have been proposed by the ESGE to be treated by endoscopic submucosal dissection (ESD). The aim of this study is to review two tertiary centers experience in the endoscopic treatment of early BE cancer by ESD.

Methods:

Clinical and technical data from Erasme Hospital (Brussels) and Westmead Hospital (Sydney) were prospectively collected from November 2013 to November 2018. Complete resection (R0) was defined as lateral and vertical margins clear of carcinoma while a curative resection was defined according to the ESGE guidelines.

Results:

Forty-nine patients, mostly women (58%), mean age of 73 years, presented a BE with a median circumference (C) of 1 (0 – 16)cm and maximal length (M) of 4.5 (0.5 – 18)cm. Each had a visible lesion of 30 (10 – 100)mm suitable for ESD. Median duration of the procedure was 90 minutes (IQR 60 – 122).

En-bloc resection was achieved in 100% of the patients and a complete endoscopic resection in 94% of cases. 29% had more than 50% circumference resected. Median specimen size was of 45 (2 – 110)mm.

Pathological examination showed the presence of carcinoma in 82% of lesions (63% pT1a) with an R0 achieved in 76% of carcinoma. Curative resection was obtained in 65% of cases. For non curative resection, 4 patients were treated surgically and the others followed endoscopically. This follow-up was available for 34 patients among who 29% received ablation therapy for remnant BE eradication. The only complications needing an intervention were strictures in 18% of patients occurring despite steroid preventive treatment for large resections.

A 6 months endoscopy follow-up was obtained in 22 patients, disclosing 72% of cases free of neoplasia and 45% free of intestinal metaplasia.

Conclusions:

ESD for large or fibrotic BE lesions is showing favorable results in term of safety and efficacy combined to ablation therapy.