Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus

Background & Aims: In view of the mortality and morbidity rates of esophage ctomy and the relatively large group of inoperable patients, local therapeu tic techniques are required for high-grade dysplasia and early Barrett's ca ncer. Methods: A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carc inoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esoph agus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and his tological grades G1 and G2 and/or high-grade dysplasia (group A). The remai ning 29 patients were included in group B (high risk). Results: A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1.3 +/- 0.6 in group A an d 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred , a case of spurting bleeding, which was managed endoscopically. Complete l ocal remission was achieved significantly earlier (P = 0.008) in group A th an in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or me tachronous carcinomas were found in 14%. Conclusions: Endoscopic mucosal re section of early carcinoma in Barrett's esophagus is associated with promis ingly low morbidity and mortality rates. The procedure may offer a new mini mally invasive therapeutic alternative to esophagectomy, especially in low- risk situations. Comparisons with surgical results will need to be done whe n the long-term results of this procedure become available.