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Endoscopic Resection with Ligation Using a Multi-Band Mucosectomy System in Barrett's Esophagus with High-Grade Dysplasia and Intramucosal Carcinoma.

Abstract：

BACKGROUND:Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving. Endoscopic resection has an increasing role. We wanted to evaluate the safety and efficacy of multi-band ligation/resection [ER-L] without pre-injection in BE with high-grade dysplasia [HGD] and intramucosal carcinoma [IMCA]. METHODS:A cohort of 65 consecutive patients from a single academic medical center, who underwent ER-L as part of endoscopic eradication therapy for BE with HGD/IMCA were studied. ER-L was performed afterendoscopic mapping and endoscopic ultrasound (EUS). Subsequently, adjunctive ablative therapies including photodynamic therapy, argon plasma coagulation and radiofrequency ablation were applied to achieve complete eradication of all BE. Thereafter biopsy surveillance was performed per protocol. All patients were prescribed a proton-pump inhibitor. MAIN OUTCOME MEASUREMENTS:Change in histopathological stage; eradication of BE and HGD/IMCA; adverse events. RESULTS:The median number of ER-L applications in each session was 4 (range 1-6) and the mean total number of ER-L sessions was 1.5. Compared with prior forceps biopsy, histopathology from the ER-L specimen changed in 24 (37.5%, p = <0.0001). With median follow-up of 15 months (range 8-42), complete and durable BE eradication was achieved with ER-L alone in 36 (60%) and the remainder with adjunctive ablation therapies. There were nine complications (four (6%) acute bleeding, five (7.5%) strictures, zero perforations). CONCLUSIONS:ER-L without submucosal (SM) pre-injection is safe and effective when applied selectively for eradication of BE with HGD/IMCA. There is significant change in pathological stage after ER-L conferring a diagnostic and staging advantage. ER-L may be used adjunctively with ablation therapies.

journal_name

Therap Adv Gastroenterol

journal_title

Therapeutic advances in gastroenterology

authors

Bhat YM,Furth EE,Brensinger CM,Ginsberg GG

doi

10.1177/1756283X09346794

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

323-30

issue

eissn

1756-283X

issn

1756-2848

journal_volume

pub_type

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Endoscopic Resection with Ligation Using a Multi-Band Mucosectomy System in Barrett's Esophagus with High-Grade Dysplasia and Intramucosal Carcinoma.