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Endoscopic resection for patients with mucosal adenocarcinoma of the esophagus

A study in the most recent issue of Gastroenterology investigates the long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. 

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Barrett’s esophagus–associated high-grade dysplasia is commonly treated by endoscopy.

However, most guidelines offer no recommendations for endoscopic treatment of mucosal adenocarcinoma of the esophagus.

Dr Christian Ell and colleagues from Germany investigated the efficacy and safety of endoscopic resection in a large series of patients with mucosal adenocarcinoma of the esophagus.

The researchers collected data from 1000 consecutive patients with mucosal adenocarcinoma of the esophagus who presented at a tertiary care center from 1996 to 2010.

Patients with low-grade and high-grade dysplasia and submucosal or more advanced cancer were excluded.

96% of patients had achieved a complete response
Gastroenterology

The team noted that all patients underwent endoscopic resection of mucosal adenocarcinoma of the esophagus.

The research team excluded patients found to have submucosal cancer at their first endoscopy examination.

After a mean follow-up period of 57 months, 96% of patients had achieved a complete response.

The team noted that surgery was necessary in 4% after endoscopic therapy failed.

Metachronous lesions or recurrence of cancer developed during the follow-up period in 140 patients but endoscopic re-treatment was successful in 115, resulting in a long-term complete remission rate of 94%.

The team observed that 111 died of concomitant disease and 2 of Barrett’s esophagus–associated cancer.

The researchers found that calculated 10-year survival rate of patients who underwent endoscopic resection of mucosal adenocarcinoma of the esophagus was 75%.

Major complications developed in 2% of patients but could be managed conservatively.

Dr Ell's team concludes, "Endoscopic therapy is highly effective and safe for patients with mucosal adenocarcinoma of the esophagus, with excellent long-term results."

"In an almost 5-year follow-up of 1000 patients treated with endoscopic resection, there was no mortality and less than 2% had major complications."

"Endoscopic therapy should become the standard of care for patients with mucosal adenocarcinoma of the esophagus."

Gastroenterol 2014: 146(3): 652-660.e1
07 March 2014

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