title: Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett's neoplasia.
abstract: BACKGROUND
  Endoscopic resection (ER) is an important treatment for high-grade intraepithelial neoplasia and early cancer in Barrett's esophagus. ER-cap requires submucosal lifting and positioning of a snare in the cap, making it technically demanding and laborious. Multiband mucosectomy (MBM) uses a modified variceal band ligator and requires no submucosal lifting or positioning of a snare.
  
  
  OBJECTIVE
  To compare ER-cap and MBM for piecemeal ER of early Barrett's neoplasia.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Tertiary-care and community-care centers.
  
  
  METHODS
  This study involved 84 patients (64 men; median age 70 years) undergoing piecemeal ER of Barrett's neoplasia.
  
  
  METHODS
  Piecemeal ER was performed by using ER-cap (n = 42) or MBM (n = 42).
  
  
  METHODS
  Safety, efficacy, procedure time, costs.
  
  
  RESULTS
  Procedure time (34 vs 50 minutes; P = .02) and costs (€240 vs €322; P < .01) were significantly less with MBM compared with ER-cap. MBM resulted in smaller resection specimens than ER-cap (18 ×13 mm vs 20 × 15 mm; P < .01). Maximum thicknesses of specimens and resected submucosa were not significantly different. There were no clinically relevant bleeding episodes. Four perforations occurred, 3 with ER-cap, 1 with MBM (P = not significant).
  
  
  CONCLUSIONS
  Potential bias because of different levels of experience among participating endoscopists.
  
  
  CONCLUSIONS
  Piecemeal ER with MBM is faster and cheaper than with ER-cap. Despite the lack of submucosal lifting, MBM appears not to be associated with more perforations. Although MBM results in slightly smaller specimens, the clinical relevance of this may be limited because depth of resections does not differ between both techniques. MBM may thus be preferred for piecemeal ER of early Barrett's neoplasia. (
  
  
  BACKGROUND
  NTR1435.).
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Pouw
authors.forename: Frederike G I
authors.initials: FG
authors.lastname: van Vilsteren
authors.forename: Femke P
authors.initials: FP
authors.lastname: Peters
authors.forename: Lorenza
authors.initials: L
authors.lastname: Alvarez Herrero
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: Ten Kate
authors.forename: Mike
authors.initials: M
authors.lastname: Visser
authors.forename: Boudewijn E
authors.initials: BE
authors.lastname: Schenk
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.forename: Frans T M
authors.initials: FT
authors.lastname: Peters
authors.forename: Martin
authors.initials: M
authors.lastname: Houben
authors.forename: Raf
authors.initials: R
authors.lastname: Bisschops
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000601:surgery; D011446:Prospective Studies