title: Efficacy and safety of EMR to completely remove Barrett's esophagus: experience in 41 patients.
abstract: BACKGROUND
  EMR is typically used to remove focal abnormalities of the esophageal mucosa. However, larger areas of Barrett's esophagus (BE) can be resected through side-by-side resections.
  
  
  OBJECTIVE
  To assess the efficacy and safety of EMR to completely remove BE.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  University of Iowa Hospitals and Clinics.
  
  
  METHODS
  Between January 2006 and December 2010, 46 patients underwent EMR for complete removal of BE. Three were lost to follow-up, one died of unrelated causes before completion, and one was still undergoing EMR treatment at the conclusion of the study. The remaining 41 patients were included for analysis. The worst histologic grade was low-grade dysplasia in 4 patients, high-grade dysplasia without cancer in 26 patients, and high-grade dysplasia with superficial adenocarcinoma in 11 patients. BE was circumferential in 65.9% of cases, and the mean (± SD) length was 3.3 ± 2.3 cm.
  
  
  METHODS
  EMR was performed by using a cap (n = 4), a multiband ligator device (n = 31), or both (n = 6), with a mean (± SD) of 2.4 ± 1.2 sessions per patient.
  
  
  METHODS
  Remission rates and complications.
  
  
  RESULTS
  Remission of high-grade dysplasia and cancer, all dysplasia, and all BE was achieved in 94.6%, 85.4%, and 78.0%, respectively. Complications included minor bleeding (31.7%), perforations (4.9%), and strictures (43.9%). All complications were managed conservatively.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  Complete removal of BE with EMR is effective but associated with a high complication rate, which is mainly related to stricture formation. This needs to be considered when choosing between available treatment modalities.
authors.affiliation: Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Henning
authors.initials: H
authors.lastname: Gerke
authors.forename: Junaid
authors.initials: J
authors.lastname: Siddiqui
authors.forename: Issam
authors.initials: I
authors.lastname: Nasr
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Van Handel
authors.forename: Chris S
authors.initials: CS
authors.lastname: Jensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D004939:Esophageal Perforation / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D019106:Postoperative Hemorrhage; D011230:Precancerous Conditions / Q000601:surgery; D012008:Recurrence