In an oral presentation at the second Presidential Plenary session at the 2020 clinical meeting of the American College of Gastroenterology (ACG), Saeed Ali, MD, from the University of Iowa Hospital and Clinics in Iowa City, Iowa, presented a report on his team’s research into “Efficacy and Safety of Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection in Barrett’s Esophagus-Related Early Neoplasia: A Systematic Review and Pooled Comparative Analysis.”

Ali and colleagues did a full text review of 109 articles and included 37 in their analysis, in which they aimed to evaluate stepwise/complete endoscopic resection (s-EMR); focal endoscopic resection with radio frequency ablation (f-EMR+RFA), or endoscopic mucosal dissection (ESD).

Their primary outcomes were recurrence of high-grade dysplasia or early adenocarcinoma, along with the risks of bleeding, strictures, and perforation with each type of procedure. Secondary outcomes were complete and en bloc resections (for ESD) and complete eradication of neoplasia with both types of EMR.

Weighted pooled rates (WPR) for recurrence, defined as histopathological evidence of early Barrett neoplasia on follow-up after the procedure, were 5.0% for f-EMR+RFA; 7.4% for s-EMR; and 10.3% for ESD. No statistical difference in recurrence of Barrett esophagus among patients treated with any endoscopic modality was found.

There was also no statistically significant difference in the risk of stricture between f-EMR+RFA and ESD, while the risk for strictures with s-EMR was 29.0%. For the risk of perforation, f-EMR+RFA was associated with lower risk while there was no statistical difference in the risk of perforation between the other 2 modalities.

“This is the first systematic review and meta-analysis for cumulative efficacy and safety, along with indirect comparative analysis to compare all three modalities,” Dr Ali stated.

—Rebecca Mashaw

Reference:

Ali S, Hussain S, Khetpal N, et. Al. Efficacy and safety of endoscopic submucosal dissection and endoscopic mucosal resection in Barrett’s esophagus-related early neoplasia: a systematic review and pooled comparative analysis. Presented at: American College of Gastroenterology 2020 Clinical Meeting and Postgraduate Course. October 27, 2020. Virtual.