title: Length of Barrett's segment predicts success of extensive endomucosal resection for eradication of Barrett's esophagus with early neoplasia.
abstract: BACKGROUND
  Although the efficacy and safety of extensive endomucosal resection (EMR) in eradicating Barrett's esophagus (BE) harbouring early neoplasia have been established, factors predicting efficacy remains unclear.
  
  
  OBJECTIVE
  To determine the complete eradication rate of Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or intramucosal carcinoma (IMC), safety, and factors predicting complete eradication by EMR.
  
  
  METHODS
  Patients with histological confirmation of Barrett's HGIN/IMC were prospectively identified. EMR was performed using Duette multiband ligator or cap technique by a single operator (NEM).
  
  
  RESULTS
  99 patients (81 males) with median age 67 years [interquartile range (IQR) 60-77 years] and median Barrett's length 4 cm (IQR 2-6 cm) were included. Of 628 index EMRs [mean 6.3, median 5 (IQR 3-8)], 23% showed IMC, 58.5% showed HGIN, and 16% showed low-grade dysplasia only. A median of 8 EMR resections per patient (IQR 6-16, 1,064 resections in 89 patients) resulted in complete eradication of BE harboring neoplasia in 49.4% and eradication of HGIN/IMC in 81% (BE <5 cm subgroup: 65% complete eradication and 91% HGIN eradication) at median follow-up of 18 months (range 6-27 months). On univariate analysis, focal dysplasia (P = 0.003) and Barrett's length <5 cm (P = 0.001) were predictors of complete BE eradication. Barrett's length <5 cm was the only significant predictor [odds ratio (OR) 3.4, standard error (SE) 0.11, P = 0.0006] on multiple logistic regression analysis. Strictures developed in 27% and major bleeding in 2% with no procedure-related perforations or mortality.
  
  
  CONCLUSIONS
  Extensive EMR for removal of BE with early neoplasia is safe. Outcomes for complete BE eradication are modest at 49.4% and eradication of high-grade dysplasia at 81%. Barrett's length <5 cm is the only significant predictor of complete response.
authors.affiliation: Division of Advanced Therapeutic Endoscopy and GI Oncology, St Michael's Hospital, Toronto, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Thomas
authors.forename: L
authors.initials: L
authors.lastname: Ayaru
authors.forename: E Y
authors.initials: EY
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Cirocco
authors.forename: G
authors.initials: G
authors.lastname: Kandel
authors.forename: G
authors.initials: G
authors.lastname: May
authors.forename: P
authors.initials: P
authors.lastname: Kortan
authors.forename: N E
authors.initials: NE
authors.lastname: Marcon
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000150:complications / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications