Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: an Italian experience.
OBJECTIVE
To evaluate endoscopic mucosal resection (EMR) in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE).


METHODS
Between June 2000 and December 2003, 39 consecutive patients with HGD (35) and/or IMC (4) underwent EMR. BE >30 mm was present in 27 patients. In three patients with short segment BE (25.0%), HGD was detected in a normal appearing BE. Lesions had a mean diameter of 14.8+/-10.3 mm. Mucosal resection was carried out using the cap method.


RESULTS
The average size of resections was 19.7+/-9.4 x 14.6+/-8.2 mm. Histopathologic assessment post-resection revealed 5 low-grade dysplasia (LGD) (12.8%), 27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%). EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwent surgery. Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy, occurred in four patients (10.3%). After a median follow-up of 34.9 mo, all patients remained in remission.


CONCLUSIONS
In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.
Conio
Massimo
M
Department of Gastroenterology, Sanremo Hospital, 18038 Sanremo, Italy. mxconio@tin.it
Repici
Alessandro
A
Cestari
Renzo
R
Blanchi
Sabrina
S
Lapertosa
Gabriella
G
Missale
Guido
G
Della Casa
Domenico
D
Villanacci
Vincenzo
V
Calandri
Pier Gigi
PG
Filiberti
Rosangela
R
D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D004947:Esophagus / Q000033:anatomy & histology / Q000473:pathology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions; D012189:Retrospective Studies; D016896:Treatment Outcome