Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett's esophagus.

BACKGROUND Endoscopic mucosal resection has been used in the treatment of superficial squamous cell cancers and gastric malignancies. Our aim was to determine whether endoscopic mucosal resection can be used in the diagnosis of lesions within Barrett's esophagus whose endoscopic appearances raise suspicion of carcinoma or high-grade dysplasia. METHODS Twenty-five patients with such lesions within Barrett's esophagus underwent endoscopic mucosal resection for diagnostic and therapeutic purposes. All patients underwent endoscopic ultrasound to determine the feasibility of endoscopic resection. Only lesions found to be uT0 or uT1 underwent EMR. The lift and cut technique was used in 23 patients and a variceal ligating device was used on 2 patients. RESULTS Endoscopic mucosal resection was performed because of a nodule or polyp within Barrett's esophagus in 11 patients (44%) and suspected superficial cancer or high-grade dysplasia in 14 patients (56%). Endoscopic mucosal resection diagnosed superficial adenocarcinoma in 13 patients (52%) and high-grade dysplasia in 4 (16%); it confirmed lesions in 8 patients (40%) to be of lower neoplastic risk. No complications occurred due to the procedure itself. CONCLUSIONS Endoscopic mucosal resection is a technique with low morbidity and mortality. It has led to a change in diagnosis in patients with Barrett's esophagus and lesions with endoscopic features that suggest neoplasia. Its major advantages include simplicity and retrieval of the specimen en bloc.

[1]  B. Overholt,et al.  Photodynamic therapy for Barrett's esophagus. , 1997, Gastrointestinal endoscopy clinics of North America.

[2]  H. Nawata,et al.  Endoscopic ultrasonography: a promising method for assessing the prospects of endoscopic mucosal resection in early gastric cancer. , 1997, Endoscopy.

[3]  K. Okita,et al.  Endoscopic Resection of Early Gastric Cancer , 1993, Endoscopy.

[4]  Mark A. Laukka,et al.  Initial results using low-dose photodynamic therapy in the treatment of Barrett's esophagus. , 1995, Gastrointestinal endoscopy.

[5]  R. Sampliner,et al.  Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. , 1996, Gastrointestinal endoscopy.

[6]  Y. Tokuda,et al.  Endoscopic Mucosectomy for Mucosal Carcinomas in the Esophagus. , 1991 .

[7]  P. Pairolero,et al.  Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy? , 1992, The Annals of thoracic surgery.

[8]  H. Makuuchi Endoscopic Mucosal Resection for Early Esophageal Cancer , 1996 .

[9]  S. Dawsey,et al.  Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. , 1996, Gastrointestinal endoscopy.

[10]  E. Moura,et al.  An endoscopic technique for resection of small gastrointestinal carcinomas. , 1996, Gastrointestinal endoscopy.

[11]  L. Bonavina Early oesophageal cancer: Results of a European multicentre survey , 1995, The British journal of surgery.

[12]  J. Vennes,et al.  Lift and cut biopsy technique for submucosal sampling. , 1976, Gastrointestinal endoscopy.