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Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus.

Abstract：

BACKGROUND & AIMS: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 (mAC). We investigated the efficacy and safety of endoscopic resection in a large series of patients with mAC. METHODS:We collected data from 1000 consecutive patients (mean age, 69.1 ± 10.7 years; 861 men) with mAC (481 with short-segment and 519 with long-segment Barrett's esophagus) who presented at a tertiary care center from October 1996 to September 2010. Patients with low-grade and high-grade dysplasia and submucosal or more advanced cancer were excluded. All patients underwent endoscopic resection of mACs. Patients found to have submucosal cancer at their first endoscopy examination were excluded from the analysis. RESULTS:After a mean follow-up period of 56.6 ± 33.4 months, 963 patients (96.3%) had achieved a complete response; surgery was necessary in 12 patients (3.7%) after endoscopic therapy failed. Metachronous lesions or recurrence of cancer developed during the follow-up period in 140 patients (14.5%) but endoscopic re-treatment was successful in 115, resulting in a long-term complete remission rate of 93.8%; 111 died of concomitant disease and 2 of Barrett's esophagus-associated cancer. The calculated 10-year survival rate of patients who underwent endoscopic resection of mACs was 75%. Major complications developed in 15 patients (1.5%) but could be managed conservatively. CONCLUSIONS:Endoscopic therapy is highly effective and safe for patients with mAC, 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 mAC.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Pech O,May A,Manner H,Behrens A,Pohl J,Weferling M,Hartmann U,Manner N,Huijsmans J,Gossner L,Rabenstein T,Vieth M,Stolte M,Ell C

doi

10.1053/j.gastro.2013.11.006

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

652-660.e1

issue

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(13)01596-5

journal_volume

146

pub_type

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Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus.