title: Endoscopic management of early esophageal neoplasia: an emerging standard.
abstract: BACKGROUND
  Endoscopic mucosal resection (EMR) and ablation technologies have markedly changed the treatment of early esophageal neoplasia. We analyzed treatment and outcomes of patients undergoing multimodal endoscopic treatment of early esophageal neoplasia at our institution.
  
  
  METHODS
  Records of patients undergoing endoscopic treatment for esophageal low-grade intraepithelial neoplasia (LGIN, n = 11), high-grade intraepithelial neoplasia (HGIN, n  = 24), or T1N0M0 neoplasia (n = 10), presenting between 2007 and 2009, were reviewed. Outcomes included eradication of neoplasia/intestinal metaplasia, development of metachronous neoplasia, and progression to surgical resection.
  
  
  RESULTS
  There were 45 patients, 96% male, with a mean age 67 years. The degree of neoplasia prior to intervention was intramucosal (8) or submucosal (2) carcinoma in 10, HGIN in 24, and LGIN in 11. Patients underwent a total of 166 procedures (median 3/patient, range 1-9). These included 120 radiofrequency ablation sessions, 38 EMRs, and 8 cryoablations. Mean follow-up was 21.3 months. Neoplasia and intestinal metaplasia were eradicated in 87.2% and 56.4% of patients, respectively, while 15.4% developed metachronous neoplasia. Three patients underwent esophagectomy. No patient developed unresectable disease or died.
  
  
  CONCLUSIONS
  Endoscopic treatment of early esophageal neoplasia is safe and effective in the short term. A minority of treated patients developed recurrent neoplasia, which is usually amenable to further endoscopic therapy. Complications are relatively minor and uncommon. Endoscopic therapy as the initial treatment for early esophageal neoplasia is an emerging standard of care.
authors.affiliation: Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Galey
authors.forename: Candice L
authors.initials: CL
authors.lastname: Wilshire
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Watson
authors.forename: Marabel D
authors.initials: MD
authors.lastname: Schneider
authors.forename: Vivek
authors.initials: V
authors.lastname: Kaul
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Jones
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Litle
authors.forename: Asad
authors.initials: A
authors.lastname: Ullah
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Peters
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome