title: Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.
abstract: OBJECTIVE
  In view of the mortality and morbidity rates of esophagectomy and the relatively large group of inoperable patients, local therapeutic techniques are required for high-grade dysplasia and early Barrett's cancer.
  
  
  METHODS
  A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carcinoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esophagus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and histological grades G1 and G2 and/or high-grade dysplasia (group A). The remaining 29 patients were included in group B (high risk).
  
  
  RESULTS
  A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1. 3 +/- 0.6 in group A and 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred, a case of spurting bleeding, which was managed endoscopically. Complete local remission was achieved significantly earlier (P = 0.008) in group A than in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or metachronous carcinomas were found in 14%.
  
  
  CONCLUSIONS
  Endoscopic mucosal resection of early carcinoma in Barrett's esophagus is associated with promisingly low morbidity and mortality rates. The procedure may offer a new minimally invasive therapeutic alternative to esophagectomy, especially in low-risk situations. Comparisons with surgical results will need to be done when the long-term results of this procedure become available.
authors.affiliation: Department of Medicine II, Horst-Schmidt-Kliniken, Wiesbaden, Germany. ell@mail.uni-mainz.de
authors.forename: C
authors.initials: C
authors.lastname: Ell
authors.forename: A
authors.initials: A
authors.lastname: May
authors.forename: L
authors.initials: L
authors.lastname: Gossner
authors.forename: O
authors.initials: O
authors.lastname: Pech
authors.forename: E
authors.initials: E
authors.lastname: Günter
authors.forename: G
authors.initials: G
authors.lastname: Mayer
authors.forename: R
authors.initials: R
authors.lastname: Henrich
authors.forename: M
authors.initials: M
authors.lastname: Vieth
authors.forename: H
authors.initials: H
authors.lastname: Müller
authors.forename: G
authors.initials: G
authors.lastname: Seitz
authors.forename: M
authors.initials: M
authors.lastname: Stolte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000601:surgery*; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome