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. 2017 Apr;60(2):129-133.
doi: 10.1503/cjs.013515.

Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma: a Canadian experience

Denise Tami Yamashita  1 , Chao Li  1 , Drew Bethune  1 , Harry Henteleff  1 , James Ellsmere  1
Affiliations

Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma: a Canadian experience

Denise Tami Yamashita et al. Can J Surg. 2017 Apr.

Abstract
in English, French

Background: Endoscopic mucosal resection (EMR) is increasingly being used as a first-line treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC). We reviewed our experience with endoscopic treatment of BE with HGD and IMC at our institution with respect to eradication rates, complications and long-term recurrence.

Methods: We performed a single-centre retrospective review of all patients referred between October 2010 and August 2014 for EMR with dysplastic BE or IMC. We performed EMR using a cap-fitted endoscope, and the procedure was repeated every 3 months until eradication or progression of disease.

Results: A total of 28 patients were identified: 16 with dysplastic BE (14 HGD, 1 low-grade dysplasia, 1 intermediate dysplasia) and 12 with IMC. Complete eradication of HGD was achieved in 11 of 14 (79%) patients. Three of 12 (25%) patients initially referred with suspected IMC were found to have invasive adenocarcinoma on EMR. Eradication was successful in 8 of 9 (89%) patients with true IMC, with 1 patient progressing to salvage esophagectomy. Complications occurred in 2 of 28 (7%) patients; both had esophageal strictures managed with dilatation. Median duration of follow-up was 371 days.

Conclusion: Our experience supports the safety of EMR as a first-line treatment for patients with BE with dysplasia and IMC in early short-term follow-up.

Contexte: La mucosectomie endoscopique est de plus en plus utilisée en première intention pour l’oesophage de Barrett avec dysplasie de haut grade (DHG) et pour l’adénocarcinome intramuqueux. Nous avons passé en revue notre expérience du traitement endoscopique de l’oesophage de Barrett avec DHG et de l’adénocarcinome intramuqueux dans notre établissement aux plans des taux d’éradication, des complications et des récurrences à long terme.

Méthodes: Nous avons procédé à une revue rétrospective de tous les cas d’oesophage de Barrett dysplasique ou d’adénocarcinome intramuqueux d’un seul centre adressés pour mucosectomie endoscopique entre octobre 2010 et août 2014. Nous avons effectué les mucosectomies endoscopiques à l’aide d’un endoscope muni d’un capuchon, et les interventions étaient répétées tous les 3 mois jusqu’àéradication ou progression de la maladie.

Résultats: En tout, 28 patients ont été recensés : 16 présentaient un oesophage de Barrett dysplasique (14 DHG, 1 dysplasie de bas grade, 1 dysplasie intermédiaire) et 12 présentaient un adénocarcinome intramuqueux. Une éradication complète de la DHG a été obtenue chez 11 patients sur 14 (79 %). Chez 3 patients sur 12 (25 %) initialement adressés pour un adénocarcinome intramuqueux, la mucosectomie a révélé un adénocarcinome envahissant. Huit patients sur 9 (89 %) atteints d’un adénocarcinome intramuqueux avéré ont subi le traitement d’éradication avec succès, et 1 patient a dû subir une oesophagectomie de sauvetage. Des complications sont survenues chez 2 patients sur 28 (7 %); les 2 patients ont présenté des sténoses oesophagiennes corrigées par dilatation. La durée médiane du suivi a été de 371 jours.

Conclusion: Notre expérience confirme l’innocuité de la mucosectomie endoscopique comme traitement de première intention chez les patients présentant un oesophage de Barrett dysplasique ou un adénocarcinome intramuqueux dans le contexte d’un suivi à court terme.

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Figures

Fig. 1
Fig. 1
Summary of patient distribution, results and follow-up. BE = Barrett esophagus; EMR = endoscopic mucosal resection; HGD = high-grade dysplasia; IMC = intramucosal adenocarcinoma; LGD = low-grade dysplasia.
See this image and copyright information in PMC

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