Endoscopic Resections for Barrett’s Neoplasia: A Long-Term, Single-Center Follow-Up Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.3. Diagnostic Evaluation and Indications
- BE with visible lesion and/or confirmed EAC, HGD, or low-grade dysplasia (LGD);
- Diagnostic workup indicated resectable lesion and no sign of metastatic disease.
2.4. Endoscopic Resection Procedure
2.5. Histopathological Assessment
2.6. Follow-Up
2.7. Study Data
2.8. Patient Selection
- Patients (age > 18) who underwent their initial EMR or ESD for either suspected or histologically confirmed BE neoplasia within the time period were included in the study.
- Patients were excluded if both the pre- and post-histopathologies revealed no presence of dysplasia.
2.9. Outcomes
- En-bloc resection rate, defined as the resection of the targeted lesion in one single piece;
- Curative resection rate, defined as complete R0 resection of HGD, EAC, and Sm1 cancer (≤500 μm) in the absence of poor prognostic factors such as a low differentiation grade and lymphovascular invasion (LVI);
- Complete remission from neoplasia and recurrences at first endoscopy FU, defined as an R0 or R1 resection of HGD or EAC with no residual or metachronous area of HGD or EAC in biopsies taken from the resection scar and mapping biopsies of the original BE segment;
- Frequency of AER during follow-up period;
- Morbidity/adverse events (AEs);
- 30-day mortality;
- Overall survival, quantified as the percentage of patients remaining alive at 1, 3, 5, and 10 years after the initial ER.
2.10. Adverse Events
2.11. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Lesion Characteristics
3.3. Procedural Characteristics
3.4. Complete R0 Resection Rate
3.5. Follow-Up
3.6. Additional Endoscopic Resections
3.7. Adverse Events and Mortality
3.8. Overall Survival Rates
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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EMR | ESD | p-Value | |
---|---|---|---|
Patients, n | 67 | 28 | |
Mean age, years, mean ± SD | 64.5 ± 10.9 | 70.6 ± 9.3 | 0.012 |
Male/female, n | 59/8 | 26/2 | 0.72 |
ASA classification (%) | n = 67 | n = 28 | 0.47 |
ASA score 1 | 14 (21) | 7 (25) | |
ASA score 2 | 34 (51) | 10 (36) | |
ASA score 3 | 18 (27) | 11 (39) | |
ASA score 4 | 1 (1) | 0 (0) | |
BE segment, n (%) | n = 64 | n = 25 | 0.305 |
Short (<3 cm) | 17 (27) | 10 (40) | |
Long (≥3 cm) | 47 (73) | 15 (60) | |
BE length, cm, median (IQR) | n = 64 | n = 25 | |
Circumferential length | 1 (0–6) | 1 (0–6) | 0.84 |
Maximal length | 4.5 (2–8) | 4 (1–7) | 0.53 |
EMR | ESD | p-Value | |
---|---|---|---|
Number of resections, n | 67 | 28 | |
Mean lesion size, mm, mean ± SD | 10.6 ± 6.6 | 19.9 ± 5.2 | 0.003 |
Lesion type | 0.085 | ||
Polypoid | 11 | 8 | |
Non-polypoid | 23 | 14 | |
Irregular mucosa | 27 | 5 | |
Unspecified | 6 | 1 | |
Paris classification, n | n = 18 | n = 23 | 0.558 |
Ip | 1 | 1 | |
Is | 3 | 7 | |
IIa | 7 | 7 | |
IIb | 3 | 2 | |
IIc | 2 | 4 | |
IIa + IIb | 0 | 2 | |
IIa + IIc | 2 | 0 | |
Pre-ER histology, n (%) | 0.158 | ||
LGD | 5 (8) | 1 (4) | |
HGD | 51 (76) | 17 (60) | |
Adenocarcinoma | |||
Intramucosal | 8 (12) | 6 (21) | |
Submucosal | 0 (0) | 1 (4) | |
Suspected deeper invasion | 2 (3) | 3 (11) | |
No dysplasia | 1 (1) | 0 | |
Location, o’clock (%) | n = 58 | n = 27 | 0.033 |
0–2 | 14 (24) | 10 (37) | |
3–5 | 30 (52) | 10 (37) | |
6–8 | 12 (21) | 2 (7) | |
9–11 | 2 (3) | 5 (19) | |
Vertical location, cm, median (IQR) | 1.75 (0–4) | 1.5 (0–3) | 0.53 |
EMR | ESD | p-Value | |
---|---|---|---|
Number of resections, n | 67 | 28 | |
Successful resection, n (%) | 65 (97.0) | 26 (92.9) | 0.58 |
Canceled | 2 | 2 | |
Duration, mean, min | 83 | 165 | <0.001 |
Resection type, n (%) | <0.001 | ||
En-bloc | 16 (25) | 23 (88) | |
Piecemeal | 49 (75) | 3 (12) | |
Mean number of pieces *, n | 3.5 | ||
En-bloc resection rate (%) | 24.6 | 88.5 | <0.001 |
Mean specimen size, mm, mean ± SD | |||
Length Width | 14.9 ± 4.3 | 35.3 ± 16.9 23.8 ± 10.9 | <0.001 |
EMR | ESD | p-Value | |
---|---|---|---|
Number of specimens, n | 65 | 26 | |
Post-ER histopathology, n (%) | 0.032 | ||
No dysplasia/other | 2 (3) | 0 (0) | 1.00 |
LGD | 12 (18) | 2 (7) | 0.335 |
HGD | 33 (51) | 9 (35) | 0.244 |
Adenocarcinoma | 18 (28) | 15 (58) | |
Intramucosal | 10 | 13 | 0.01 |
Submucosal (sm1) | 0 | 1 | 1.00 |
Submucosal(>sm1) | 5 | 0 | 0.316 |
T2 or deeper | 3 | 1 | 1.00 |
Differentiation grade, n (%) | n = 9 | n = 12 | 0.401 |
G1 | 3 (33) | 8 (67) | |
G2 | 4 (45) | 3 (25) | |
G3 | 2 (22) | 1 (8) | |
Lymphovascular invasion, n/n (%) | N/A | 2/12 (16.6) | |
R0 resection of neoplasia, n/n (%) | 29/51 (56.8) | 18/24 (75) | 0.20 |
Complete R0 resection of neoplasia, n/n (%) | 8/51 (16) | 15/24 (62.5) | <0.001 |
HGD | 8/33 (24.2) | 7/9 (77.7) | |
Adenocarcinoma | |||
Intramucosal | 0/10 (0) | 6/12 (50) | |
Submucosal (sm1) | 0/5 (0) | 2/2 (100) | |
Invasive | 0/3 (0) | 0/1 (0) | |
Curative resection of neoplasia, n/n (%) | 8/51 (16) | 13/24 (54) | <0.001 |
HGD | 8/33 | 7/9 | |
Adenocarcinoma | 0/18 | 6/15 | |
Intramucosal | 0/10 | 6/12 | |
Submucosal (sm1) | 0/5 | 0/2 | |
Invasive | 0/3 | 0/1 |
EMR | ESD | p-Value | |
---|---|---|---|
Patients, n | 67 | 28 | |
Post-ER treatment decision, n/n (%) | 0.038 | ||
Endoscopic FU | 50 (75) | 21 (75) | 1.00 |
Surgery | 12 (18) | 1 (4) | 0.099 |
Brachytherapy | 0 | 1 (4) | 0.298 |
Radiotherapy | 2 (3) | 4 (14) | 0.062 |
Lost to follow-up/other reason | 3 (4) | 1 (4) | 1.00 |
Endoscopic FU | |||
Follow-up time, months, mean ± SD | 79.8 ± 48.2 | 49.2 ± 27.4 | 0.002 |
Follow-up time, months, median (range) | 90 (2–174) | 61 (5–91) | 0.011 |
Complete remission at first FU, n/n (%) | 0.069 | ||
HGD | 20/33 (61) | 7/9 (78) | 0.45 |
Intramucosal | 0/2 | 9/10 (90) | 0.045 |
Total | 20/35 (57) | 16/19 (84) | |
Patients requiring AER, n (%) | 22 (44) | 3 (14) | 0.028 |
Number of AERs, n | 0.026 | ||
EMR | 23 | 0 | |
ESD | 13 | 4 | |
Total | 36 | 4 | |
No. of AERs per patient, n | |||
1 | 16 | 2 | |
2 | 2 | 1 | |
3 | 1 | 0 | |
4 | 2 | 0 | |
5 | 1 | 0 | |
Days until first AER, median, n (range) | 246 (27–1108) | 726 (282–1869) | |
Ablation, n/n (%) | 35/50 (70) | 8/21 (38) | 0.017 |
Other treatment (during endoscopic FU), n/n (%) | |||
Radiotherapy | 3/50 (6) | 0/21 | |
Surgery | 3/50 (6) | 1/21 (5) |
EMR | ESD | |
---|---|---|
Resections, n | 23 | 17 |
Mean age, years | 62.4 ± 11.4 | 70.6 ± 6.7 |
Pre-ER histology, n (%) | ||
HGD | 19 | 14 |
Adenocarcinoma | ||
Intramucosal | 3 | 1 |
Submucosal | 0 | 0 |
Invasive | 0 | 2 |
No biopsy | 1 | 0 |
Total | 23 | 17 |
Successful resection, n (%) | 23 (100) | 17 (100) |
Duration, mean, min | 71 | 164 |
En-bloc resection rate (%) | 8/23 (35) | 14/17 (84) |
Histology, n (%) | ||
LGD | 4 | 1 |
HGD | 14 | 10 |
Adenocarcinoma | ||
Intramucosal | 4 | 5 |
No dysplasia/other | 1 | 1 |
Complete R0 resection of neoplasia, n/n (%) | 2/18 (11) | 9/15 (61) |
Curative resection of neoplasia, n/n (%) | 2/18 (11) | 9/15 (61) |
EMR | ESD | |
---|---|---|
Patients, n | 67 | 28 |
Complications, n (%) | ||
Bleeding | 0 (0) | 0 |
Perforation | 1 (1.5) | 1 (3.5) |
Stricture | 2 (3) | 1 (3.5) |
30-day mortality, n (%) | 1 (1.5) | 0 (0) |
EMR | ESD | |
---|---|---|
Resections, n | 90 | 45 |
Complications, n (%) | ||
Bleeding | 2 (2) | 0 |
Perforation | 1 (1) | 2 (4.5) |
Stricture | 3 (3.5) | 2 (4.5) |
30-day mortality | 1 (1) | 0 |
Log-Rank Chi-Square | df | p-Value | Cox Model HR (95% CI) | p-Value | |
---|---|---|---|---|---|
Treatment method EMR * vs. ESD | 2.190 | 1 | 0.139 | 0.988 (0.459–2.127) | 0.975 |
ASA classification ASA 1–2 * vs. ASA 3–4 | 12.813 | 1 | <0.001 | 2.281 (1.184–4.393) | 0.014 |
Age ≤69 years * vs. >69 years | 16.275 | 1 | <0.001 | 2.517 (1.256–5.043) | 0.009 |
Post-ER histopathology HGD or less * vs. T1a or worse | 3.551 | 1 | 0.059 | 1.833 (0.945–3.556) | 0.073 |
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Löfdahl, P.; Edebo, A.; Wolving, M.; Bratlie, S.O. Endoscopic Resections for Barrett’s Neoplasia: A Long-Term, Single-Center Follow-Up Study. Medicina 2024, 60, 1074. https://doi.org/10.3390/medicina60071074
Löfdahl P, Edebo A, Wolving M, Bratlie SO. Endoscopic Resections for Barrett’s Neoplasia: A Long-Term, Single-Center Follow-Up Study. Medicina. 2024; 60(7):1074. https://doi.org/10.3390/medicina60071074
Chicago/Turabian StyleLöfdahl, Per, Anders Edebo, Mats Wolving, and Svein Olav Bratlie. 2024. "Endoscopic Resections for Barrett’s Neoplasia: A Long-Term, Single-Center Follow-Up Study" Medicina 60, no. 7: 1074. https://doi.org/10.3390/medicina60071074