title: Circumferential EMR and complete removal of Barrett's epithelium: a new approach to management of Barrett's esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma.
abstract: BACKGROUND
  There is no study of circumferential EMR in patients with Barrett's esophagus containing early stage malignant lesions. This study investigated the effectiveness and safety of circumferential EMR by using a simple snare technique without cap.
  
  
  METHODS
  Patients with Barrett's esophagus containing multifocal high-grade intraepithelial neoplasia or intramucosal cancer, and patients with endoscopically nonidentifiable early stage malignant mucosal changes incidentally detected in random biopsy specimens were included in the study. A 30 x 50-mm polypectomy snare made of monofilament 0.4-mm steel wire was used without any additional device or submucosal injection.
  
  
  RESULTS
  Twelve patients (10 men, 2 women; median age 63.5 years, range 43-88 years) underwent circumferential EMR; 5 had multifocal lesions, and 7 had no visible lesions. Segments of Barrett's epithelium were circumferential (median length 5 cm) and completely removed. The median number of EMR sessions was 2.5. The median number of snare resections per EMR session was 5. The medial total area of mucosa in resected specimens per session was 3.8 cm(2). Two patients developed strictures that were successfully treated by bougienage. Minor bleeding occurred during 4 of 31 EMR sessions. During a median follow-up of 9 months, no recurrence of Barrett's esophagus or malignancy was observed.
  
  
  CONCLUSIONS
  Circumferential EMR with a simple snare technique is feasible, safe, and effective for complete removal of Barrett's epithelium with early stage malignant changes.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Uwe
authors.initials: U
authors.lastname: Seitz
authors.forename: Boris
authors.initials: B
authors.lastname: Brand
authors.forename: Stefan
authors.initials: S
authors.lastname: Groth
authors.forename: Gerardo
authors.initials: G
authors.lastname: Mendoza
authors.forename: Xikun
authors.initials: X
authors.lastname: He
authors.forename: Frank
authors.initials: F
authors.lastname: Thonke
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Soeren
authors.initials: S
authors.lastname: Schroeder
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery