title: Complete Barrett's excision by stepwise endoscopic resection in short-segment disease: long term outcomes and predictors of stricture.
abstract: OBJECTIVE
  Complete Barrett's excision (CBE) of short-segment Barrett's high grade dysplasia (HGD) and early esophageal adenocarcinoma by stepwise endoscopic resection is a precise staging tool, detects covert synchronous disease, and may produce a sustained treatment response. Esophageal stricture is the most commonly reported complication of CBE although risk factors have not yet been clearly defined.
  
  
  METHODS
  Data were recorded prospectively on patients with limited co-morbidity and age ≤ 80 years undergoing CBE for histologically proven HGD or esophageal adenocarcinoma within ≤ C3M5 segments. Endoscopic resection was performed by standardized protocol every 6 - 8 weeks until CBE was achieved. Esophageal dilation was performed when patients reported dysphagia. Dysphagia scores were recorded at scheduled endoscopic surveillance or by telephone interview.
  
  
  RESULTS
  By intention-to-treat analysis, complete eradication of neoplasia and intestinal metaplasia was achieved in 95 % and 82 %, respectively, in 77 patients undergoing a median of 2 resection sessions (interquartile range [IQR] 1 - 3). Esophageal dilation was required in 33 % (median 3 dilations, IQR 1 - 3.5) at median follow-up of 20 months (IQR 6 - 40). Independent risk factors for dilation requirement were the number of mucosal resections at the index procedure (odds ratio [OR] 1.3 per resection, 95 % confidence interval [CI] 1.0 - 1.9; P = 0.043) and maximal extent of the Barrett's segment (OR 2.2 per cm, 95 %CI 1.2 - 3.9; P = 0.009).
  
  
  CONCLUSIONS
  Although CBE is highly effective in the treatment of Barrett's HGD and esophageal adenocarcinoma, the risk of post-CBE dysphagia increases with the maximal extent of the Barrett's segment and the number of mucosal resections at the index procedure. These data could be used to inform treatment decisions and identify those patients who may benefit from prophylactic therapies such as dilation.
authors: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors: A
authors: A
authors: Chung
authors: M J
authors: MJ
authors: Bourke
authors: L F
authors: LF
authors: Hourigan
authors: G
authors: G
authors: Lim
authors: A
authors: A
authors: Moss
authors: S J
authors: SJ
authors: Williams
authors: D
authors: D
authors: McLeod
authors: S
authors: S
authors: Fanning
authors: V
authors: V
authors: Kariyawasam
authors: K
authors: K
authors: Byth
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012008:Recurrence