title: Endoscopic Resection with Ligation Using a Multi-Band Mucosectomy System in Barrett's Esophagus with High-Grade Dysplasia and Intramucosal Carcinoma.
abstract: BACKGROUND
  Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving. Endoscopic resection has an increasing role. We wanted to evaluate the safety and efficacy of multi-band ligation/resection [ER-L] without pre-injection in BE with high-grade dysplasia [HGD] and intramucosal carcinoma [IMCA].
  
  
  METHODS
  A cohort of 65 consecutive patients from a single academic medical center, who underwent ER-L as part of endoscopic eradication therapy for BE with HGD/IMCA were studied. ER-L was performed afterendoscopic mapping and endoscopic ultrasound (EUS). Subsequently, adjunctive ablative therapies including photodynamic therapy, argon plasma coagulation and radiofrequency ablation were applied to achieve complete eradication of all BE. Thereafter biopsy surveillance was performed per protocol. All patients were prescribed a proton-pump inhibitor.
  
  
  METHODS
  Change in histopathological stage; eradication of BE and HGD/IMCA; adverse events.
  
  
  RESULTS
  The median number of ER-L applications in each session was 4 (range 1-6) and the mean total number of ER-L sessions was 1.5. Compared with prior forceps biopsy, histopathology from the ER-L specimen changed in 24 (37.5%, p = <0.0001). With median follow-up of 15 months (range 8-42), complete and durable BE eradication was achieved with ER-L alone in 36 (60%) and the remainder with adjunctive ablation therapies. There were nine complications (four (6%) acute bleeding, five (7.5%) strictures, zero perforations).
  
  
  CONCLUSIONS
  ER-L without submucosal (SM) pre-injection is safe and effective when applied selectively for eradication of BE with HGD/IMCA. There is significant change in pathological stage after ER-L conferring a diagnostic and staging advantage. ER-L may be used adjunctively with ablation therapies.
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ybhat@mednet.ucla.edu.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Bhat
authors.forename: Emma E
authors.initials: EE
authors.lastname: Furth
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brensinger
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg