title: Clinical outcomes of endoscopic submucosal dissection for superficial Barrett's adenocarcinoma.
abstract: BACKGROUND
  Advances in diagnostic techniques have allowed early stage detection of superficial Barrett's adenocarcinoma (SBA) as well as resection by endoscopic submucosal dissection (ESD). Few reports exist, however, on the safety and efficacy of ESD for SBA.
  
  
  OBJECTIVE
  To analyze outcomes of ESD for SBA in relation to clinicopathological features of the lesions.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-three patients (21 men, 2 women; mean age, 63 years) with 26 SBAs.
  
  
  METHODS
  We examined outcomes of ESD in relation to the clinicopathological features of SBAs. The main outcomes assessed were en bloc resection rate, operation time, adverse event rates, additional resection rate, and time between ESD and any recurrence.
  
  
  RESULTS
  Twenty lesions (87%) derived from short-segment Barrett's esophagus, and 3 lesions (13%) derived from long-segment Barrett's esophagus. The majority of SBAs (54%) were located in the 0 to 3 o'clock circumferential quadrant. Median tumor size was 15 mm (range 5-60 mm). Macroscopic types were flat elevated (n = 13, 50%), depressed (n = 12, 46%), and protruded (n = 1, 4%). The SBAs appeared red (n = 23, 88%) or normally pale (n = 3, 12%). Under magnifying narrow-band imaging, all SBAs showed an irregular mucosal pattern and an irregular vascular pattern. The endoscopic en bloc resection rate was 100% (26/26), and the pathological en bloc resection rate was 85% (22/26). The median procedure time was 95 minutes (range, 30-210 minutes). Delayed bleeding occurred in 1 case, but there was no perforation. The SBAs were of the differentiated type (n = 25, 96%) or poorly differentiated type (n = 1, 4%). The tumor had invaded the superficial muscularis mucosa (n = 3, 12%), lamina propria mucosa (n = 5, 19%, deep muscularis mucosa (n = 9, 34%), SM1 (n = 3, 12%), and SM2 (n = 6, 23%). Additional surgical resection after ESD was performed in 9 cases, and there were no residual tumors, but 1 lymph node metastasis was found. There were no recurrent tumors; however, 1 metachronous adenocarcinoma was diagnosed 42 months after ESD.
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  ESD appears to be a safe and effective treatment strategy for early stage SBA.
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kagemoto
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Miwata
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Urabe
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Sanomura
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Health Service Center, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hiyama
authors.affiliation: Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology; D004210:Dissection / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D062048:Narrow Band Imaging; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D061646:Operative Time; D012189:Retrospective Studies