Bipolar ESD in Barrett’s early cancer – improving histological evaluation of the R0 resection margin

Endoscopic R0 resection via ESD procedures is an evolving field in treatment of early GI cancer. Bipolar resection devices such as the SpeedBoat™ are supposed to create a deeper resection margin at the muscle layer, fewer charring and a safer resection due to the protective hull of the device. In our clinical case we demonstrate a resection specimen of a T1 sm1 Barrett’s cancer with clear R0 resection margins improving histological evaluation.

The Case: A 52y old male patient presented with reflux disease and a suspected C0M1 Barrett with high grade dysplasia in random biopsies. Further evaluation showed a limited area of 1x1cm at 8:00 suspected for dysplasia [1] [2] [3].

Using the bipolar SpeedBoat UltraSlim™ device, an ESD was performed in deep sedation, with a resected specimen of 1,5 x 2cm including safety margins. We treated minor bleeding using microwave effect, no late perforation occurred.

Histological specimen revealed pT1sm1 cancer, the R0 resection margins only with neglectable heat effects compared to monopolar resection.

A 3-month follow-up showed no residual dysplasia, RFA of the remaining Barrett’s epithelium completed the treatment.

Conclusion: Bipolar ESD with the new SpeedBoat UltraSlim™ device is a safe treatment for dysplastic Barrett and early cancer, improving histological evaluation to avoid surgical over-treatment.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Tsiamoulos Zacharias P. et al. to endoscopic submucosal tunneling dissection: the “Speedboat-RS2” device. Endoscopy 2019; 51: E185-E186
• 2 Nabi Z, Reddy N. New Kid on the Block: “Speedboat� Journal of Digestive Endoscopy. 13 No. 2/2022 doi:10.1055/s-0042-1749335. ISSN 0976-5042.
• 3 Tsiamoulos Zacharias P. et al. A novel multimodality endoscopic device for colonic submucosal dissection using a combination of bipolar radiofrequency and microwave modalities. Endoscopy 2016; 48: 271-276