title: Early metal stent insertion fails to prevent stricturing after single-stage complete Barrett's excision for high-grade dysplasia and early cancer.
abstract: BACKGROUND
  Barrett's esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) can be effectively treated by single-session EMR, resulting in complete Barrett's excision (CBE). CBE provides accurate histology for staging and clinical confirmation of neoplasia eradication but is limited by a high risk of esophageal stricture formation.
  
  
  OBJECTIVE
  To evaluate the effectiveness of prophylactic temporary esophageal stenting to prevent post-CBE stricture formation.
  
  
  METHODS
  Single-center, investigator-initiated feasibility study.
  
  
  METHODS
  Circumferential, short-segment Barrett's esophagus (≤C3≤M5) with HGD or IMC.
  
  
  METHODS
  Single-stage CBE and insertion of a fully covered metal esophageal stent at 10 days that was removed at 8 weeks. Patients were followed for a minimum of 2 surveillance endoscopies.
  
  
  METHODS
  Symptomatic esophageal stricture formation.
  
  
  RESULTS
  At the end of the follow-up period, 8 patients (57.1%) required esophageal dilation for symptomatic CBE-related (n = 7) or stent-related (n = 4) strictures. A median of 3 surveillance endoscopies were performed over a median endoscopic follow-up of 17 months (range 4-25 months). Single-stage CBE successfully eliminated Barrett's intestinal metaplasia and neoplasia in 71.4% and 92.9% of patients, respectively. Four patients were admitted to the hospital, and 4 patients had early stent removal because of pain or dysphagia.
  
  
  CONCLUSIONS
  Single-center feasibility study.
  
  
  CONCLUSIONS
  In a prospective study evaluating prophylactic esophageal stent insertion after single-stage CBE, esophageal strictures formed in more than of half the study cohort, and stents were associated with significant morbidity. An alternative method to reduce stricture formation is required. (
  
  
  BACKGROUND
  NCT01554280.).
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Bronte A
authors.initials: BA
authors.lastname: Holt
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Vanoo
authors.initials: V
authors.lastname: Jayasekeran
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Eric Y T
authors.initials: EY
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Farzan F
authors.initials: FF
authors.lastname: Bahin
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sonson
authors.affiliation: St. Vincent's Centre for Applied Medical Research, University of Notre Dame School of Medicine, and University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Reginald V
authors.initials: RV
authors.lastname: Lord
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D065311:Adenocarcinoma in Situ / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000517:prevention & control*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D017211:Treatment Failure