Endoscopic mucosal or submucosal resection of early neoplasia in Barrett's esophagus after antireflux surgery.
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.
Van Den Eynde
Marc
M
Gastroenterology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Jouret-Mourin
Anne
A
Sempoux
Christine
C
Piessevaux
Hubert
H
Deprez
Pierre H
PH
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