title: Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus.
abstract: OBJECTIVE
  Barrett's esophagus-associated high-grade dysplasia is commonly treated by endoscopy. However, most guidelines offer no recommendations for endoscopic treatment of mucosal adenocarcinoma of the esophagus (mAC). We investigated the efficacy and safety of endoscopic resection in a large series of patients with mAC.
  
  
  METHODS
  We collected data from 1000 consecutive patients (mean age, 69.1 ± 10.7 years; 861 men) with mAC (481 with short-segment and 519 with long-segment Barrett's esophagus) who presented at a tertiary care center from October 1996 to September 2010. Patients with low-grade and high-grade dysplasia and submucosal or more advanced cancer were excluded. All patients underwent endoscopic resection of mACs. Patients found to have submucosal cancer at their first endoscopy examination were excluded from the analysis.
  
  
  RESULTS
  After a mean follow-up period of 56.6 ± 33.4 months, 963 patients (96.3%) had achieved a complete response; surgery was necessary in 12 patients (3.7%) after endoscopic therapy failed. Metachronous lesions or recurrence of cancer developed during the follow-up period in 140 patients (14.5%) but endoscopic re-treatment was successful in 115, resulting in a long-term complete remission rate of 93.8%; 111 died of concomitant disease and 2 of Barrett's esophagus-associated cancer. The calculated 10-year survival rate of patients who underwent endoscopic resection of mACs was 75%. Major complications developed in 15 patients (1.5%) but could be managed conservatively.
  
  
  CONCLUSIONS
  Endoscopic therapy is highly effective and safe for patients with mAC, with excellent long-term results. In an almost 5-year follow-up of 1000 patients treated with endoscopic resection, there was no mortality and less than 2% had major complications. Endoscopic therapy should become the standard of care for patients with mAC.
authors.affiliation: Department of Gastroenterology and Interventional Endoscopy, St John of God Hospital, University of Regensburg, Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Pech
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: May
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Manner
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Behrens
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pohl
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Weferling
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Urs
authors.initials: U
authors.lastname: Hartmann
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Manner
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany.
authors.forename: Josephus
authors.initials: J
authors.lastname: Huijsmans
authors.affiliation: Department of Internal Medicine II, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Liebwin
authors.initials: L
authors.lastname: Gossner
authors.affiliation: Department of Gastroenterology, Diakonissen Krankenhaus, Speyer, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rabenstein
authors.affiliation: Institute of Pathology, Bayreuth Hospital, University of Erlangen-Nuremberg, Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Department of Pathology, Klinikum Kulmbach, Kulmbach, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, University of Mainz, Wiesbaden, Germany. Electronic address: christian.ell@medizin-first.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Barrett’s Esophagus; Endoscopic Mucosal Resection; Esophageal Cancer