title: Endoscopic mucosal or submucosal resection of early neoplasia in Barrett's esophagus after antireflux surgery.
abstract: BACKGROUND
  Endoscopic resection and radiofrequency ablation are now established therapies for high-grade intraepithelial neoplasia and mucosal cancer complicating Barrett's esophagus. These techniques may be more challenging in patients with previous antireflux surgery, because of poor visibility and accessibility.
  
  
  OBJECTIVE
  To assess the results of endoscopic resection for early neoplasia complicating Barrett's esophagus after antireflux surgery.
  
  
  METHODS
  Case series, retrospective review.
  
  
  METHODS
  Single tertiary-care referral center.
  
  
  METHODS
  This study involved 7 patients treated for Barrett's neoplasia by endoscopic resection between 2001 and 2009.
  
  
  METHODS
  Endoscopic resection was performed by using the EMR cap technique or by endoscopic submucosal dissection.
  
  
  METHODS
  The curative resection rate, complications, follow-up, and complete remission status were determined.
  
  
  RESULTS
  Seven patients underwent endoscopic resection (mean number of sessions, 3.1; range, 1-6): endoscopic submucosal dissection in 3 patients and EMR in 4 patients. Two patients needed additional argon plasma coagulation. Pathology examination disclosed invasive adenocarcinoma in 3 patients and high-grade intraepithelial neoplasia in 4 patients. At the last follow-up examination, all patients were in complete remission. Major procedure-related complications were not encountered.
  
  
  CONCLUSIONS
  Small number of patients, single center, retrospective study.
  
  
  CONCLUSIONS
  We demonstrated that full endoscopic resection by using EMR or endoscopic submucosal dissection in patients with previous antireflux surgery can be achieved successfully and safely. These patients can be treated endoscopically, similarly to patients without previous surgery.
authors.affiliation: Gastroenterology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Van Den Eynde
authors.forename: Anne
authors.initials: A
authors.lastname: Jouret-Mourin
authors.forename: Christine
authors.initials: C
authors.lastname: Sempoux
authors.forename: Hubert
authors.initials: H
authors.lastname: Piessevaux
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Deprez
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D001471:Barrett Esophagus / Q000150:complications*; D002278:Carcinoma in Situ / Q000209:etiology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000209:etiology / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies