title: Endoscopic resection with or without mucosal ablation of high grade dysplasia and early oesophageal adenocarcinoma--long term follow up from a regional UK centre.
abstract: BACKGROUND
  Endoscopic resection (ER) is emerging as a curative technique in patients with high-grade dysplasia (HGD), intramucosal cancer (IMC), and early submucosal cancer (T1sm1) within Barrett's oesophagus.
  
  
  METHODS
  This consecutive case series of 72 patients with HGD or IMC reports outcomes of ER, with or without mucosal ablation, in a single institution after a median of 38 months follow-up between 2004 and 2011. The primary outcome was disease progression to submucosal invasion. Secondary outcomes included disease regression, the effect of ER on staging compared to biopsy and procedure-related complications.
  
  
  RESULTS
  72 patients (mean age 73.0 - range 52.0-93.0) were treated by ER ± ablative therapy with curative intent for HGD (88% patients) or IMC (12%). 38% had one or more severe systemic co-morbidities. A median of 4 (1-11) procedures were undertaken per patient. In addition to ER, 43% of patients were treated with argon plasma coagulation, 17% with radiofrequency ablation, and 11% with photodynamic therapy. 8 (13%) patients with HGD at baseline and 0 (0%) with IMC progressed to invasive carcinoma. The median time to progression was 26.3 and 12.6 months respectively. 51% patients experienced disease regression. Disease staging was upgraded by ER in 27% of patients.
  
  
  CONCLUSIONS
  This case series reports on a minimally invasive technique in an elderly population with multiple co-morbidities, demonstrating disease regression with long-term follow-up.
  
  
  CONCLUSIONS
  ER ± ablation is an effective and potentially curative option for patients with HGD or IMC. The benefit of endoscopic resection for disease staging was clearly demonstrated.
authors.affiliation: Department of Oesophagogastric and General Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, UK. Electronic address: zoe.oliphant@gmail.com.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Oliphant
authors.affiliation: Department of Oesophagogastric and General Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Snow
authors.affiliation: Department of Oesophagogastric and General Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Knight
authors.affiliation: Department of Oesophagogastric and General Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Barr
authors.affiliation: Department of Oesophagogastric and General Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Almond
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010778:Photochemotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Adenocarcinoma; Barrett's; Dysplasia; Endoscopic mucosal resection