title: One-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia.
abstract: OBJECTIVE
  Focal endoscopic mucosal resection (EMR) of visible intraepithelial lesions arising within Barrett's esophagus (BE) may miss synchronous lesions that are not endoscopically apparent. Stepwise radical endoscopic resection would obviate this concern by removing all BE; however, it requires repeated endoscopy which may increase the risk of complications, particularly for patients with circumferential BE. The aim of the study was to evaluate the safety and efficacy of one-step complete circumferential resection of BE by cap-assisted EMR (EMR-C) among patients with circumferential BE and high-grade dysplasia or intramucosal carcinoma.
  
  
  METHODS
  Between January 2003 and March 2010, 47 patients with circumferential BE and biopsy-proven high-grade dysplasia or intramucosal cancer underwent EMR-C. We evaluated: (1) complete eradication of neoplasia, (2) complete eradication of metaplasia, and (3) complications including bleeding and esophageal stricture.
  
  
  RESULTS
  Complete eradication of neoplasia and complete eradication of metaplasia were achieved after a median follow-up of 18.4 months in 91% (43/47) of patients. After EMR-C, two patients (one IMC, one invasive cancer) underwent esophagectomy. Histology of the resected specimens showed no residual disease and a T1bN0 lesion, respectively. Two patients had progression of neoplasia. A stenosis occurred in 18 out of 45 patients (40%). All stenoses were treated with dilations and two required temporary placement of a covered stent.
  
  
  CONCLUSIONS
  One-step complete EMR-C is a safe and effective technique which can be considered in patients with early neoplastic lesions. Although 40% of patients developed dysphagia, this could well be managed endoscopically.
authors.affiliation: Department of Gastroenterology, General Hospital, Sanremo, Italy. Electronic address: mxconio@tin.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
authors.affiliation: Department of Gastroenterology, Durham Veterans Affairs Medical Center and Duke Medical Center, NC, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.affiliation: Department of Gastroenterology, General Hospital, Sanremo, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Blanchi
authors.affiliation: Department of Pathology, General Hospital, Sanremo, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Ruggeri
authors.affiliation: Epidemiology, Biostatistics and Clinical Trials, IRCCS, San Martino - IST National Institute for Cancer Research, Genova, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Filiberti
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000150:complications* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies