Endoscopic therapy for early neoplasia in Barrett's esophagus is evolving rapidly.
Dr Jacques Bergman and colleagues from the Netherlands prospectively evaluated safety of stepwise radical endoscopic resection of Barrett's containing early neoplasia.
Patients with early neoplasia in Barrett's 5 cm or less, without signs of submucosal infiltration or lymph node/distant metastases, were included.
The patients underwent resection sessions with intervals of 6 weeks.
Between 2003 and 2004, the team of doctors assessed 39 consecutive patients.
Therapy was discontinued in 2 patients due to unrelated comorbidity.
Complete eradication of early neoplasia was achieved in all 37 treated patients in a median number of 3 sessions.
The doctors found that complete removal of all Barrett's mucosa was achieved in 89% patients.
|Complications occurred in 2% of endoscopic resection procedures|
|American Journal of Gastroenterology|
The team noted that 4 patients were found to have small isles of Barrett's mucosa underneath neosquamous mucosa.
Complications occurred in 2% of endoscopic resection procedures, which included asymptomatic perforation, and delayed bleeding.
The doctors noted that symptomatic stenosis occurred in 26% of patients, and was effectively treated by endoscopic bougienage.
During a median follow-up of 11 months, no patients died and none had recurrence of neoplasia or Barrett's mucosa.
Dr Bergman's team concludes, “Stepwise radical endoscopic resection is effective for selected patients with early neoplasia in Barrett's esophagus.
It provides optimal histopathological diagnosis, and may reduce recurrence rate, since all mucosa at risk is effectively removed.”
“Use of argon plasma coagulation should be limited to prevent buried Barrett's mucosa.”
“Methods for prevention of stenosis should be developed.”