title: Complete endoscopic mucosal resection is effective and durable treatment for Barrett's-associated neoplasia.
abstract: OBJECTIVE
  Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) is treated by complete eradication of areas of BE by endoscopic mucosal resection (EMR). By using this approach, histologic analysis also can be performed. We investigated the effectiveness, safety, and durability of this approach, as well as its use in diagnosis after a single referral.
  
  
  METHODS
  We collected data from 107 patients who were referred to the Center for Endoscopic Research and Therapeutics at the University of Chicago for BE (mean length, 3.6 cm) with suspected HGD or IMC, from August 2003 through December 2012. All patients underwent EMR and were followed up through January 2014 (mean follow-up time, 40.6 mo). The primary outcome was treatment efficacy (complete eradication of BE and associated neoplasia); secondary outcomes included safety, durability, and accuracy of diagnosis.
  
  
  RESULTS
  BE was eradicated completely by EMR in 80.4% (86 of 107) of patients based on intention-to-treat analysis, and in 98.8% (79 of 80) of patients based on per-protocol analysis. The diagnosis was changed for 25% of patients after EMR, including 4 cases that initially were diagnosed as HGD by biopsy analysis and subsequently were found to have evidence of submucosal invasion when EMR specimens were assessed. Strictures and symptomatic dysphagia developed in 41.1% and 37.3% of patients, respectively, with an average of 2.3 dilations required. Perforations occurred in 2 patients after EMR and in 1 patient after dilation. HGD and IMC recurred in 1 patient each; both were treated successfully with EMR. Based on pathology analysis of the most recently collected specimens, 71.6% of patients (53 of 74) were in complete remission from intestinal metaplasia and 100% were in complete remission from HGD (74 of 74) or cancer (74 of 74).
  
  
  CONCLUSIONS
  For patients with BE with HGD or neoplasia, complete EMR is an effective and durable treatment and is a relatively safe technique. Specimens collected by EMR also can be analyzed histologically to aid in diagnosis. The common complication of EMR is esophageal stricture, which can be addressed with endoscopic dilation.
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Vani J A
authors.initials: VJ
authors.lastname: Konda
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Mariano
authors.initials: M
authors.lastname: Gonzalez Haba Ruiz
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.affiliation: Department of Pathology, University of Chicago Medicine, Chicago, Illinois.
authors.forename: John
authors.initials: J
authors.lastname: Hart
authors.affiliation: Department of Pathology, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Xiao
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Posner
authors.affiliation: Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois. Electronic address: iwaxman@medicine.bsd.uchicago.edu.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery*; D002641:Chicago; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: Adenocarcinoma; Endoscopy; Endotherapy; Esophageal Cancer