4 Questions About Endoscopic Submucosal Dissection in Barrett Esophagus–Related Superficial Neoplasia

The difference in long-term outcomes of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for Barrett esophagus (BE)–related superficial neoplasia is unclear.

To address this, Lady Katherine Mejia Perez, MD, from the Department of Internal Medicine at the Cleveland Clinic in Ohio, and colleagues conducted a study that determined the rates of local and metachronous recurrence of ESD and EMR among patients with BE-associated high-grade dysplasia and stage T1a esophageal adenocarcinoma.

Findings of the study indicated that ESD resulted in significantly lower recurrence rates and less need for a repeated endoscopic therapeutic procedure than EMR.

Gastroenterology Consultant spoke about the research with Dr Mejia Perez at the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting and Postgraduate Course.

Gastroenterology Consultant: What prompted you to conduct the study?

Lady Mejia Perez: Patients with BE with associated superficial neoplasia usually undergo endoscopic resection for resection of their nodule. When they have recurrence during their follow-up, they undergo repeated endoscopic resection procedures. However, the repeated interventions, of course, come with a cost. We conducted this study because we know that ESD has multiple advantages. First, ESD achieves higher en bloc and R0 resection for superficial cancers within the gastrointestinal (GI) tract, including squamous cell carcinoma, gastric cancer, and colorectal cancer. This translates into proper assessment of the histopathology margins, and lower rate of recurrence. However, we do not have enough data on the clinical long-term outcomes for BE-associated neoplasia, because these pathologies are not as common in the East, where ESD is more commonly performed, and there is a different standard of care in Western countries.

GASTRO CON: What is the most important finding from the study?

LMP: The most important finding is that ESD was proven to achieve higher en bloc and R0 resection as we believed, and it translated into lower recurrence rates later on. Patients had lower recurrence rates, therefore, they had a lower need of repeat endoscopic procedures during their surveillance in order to eliminate recurrence. I would like to promote awareness about the role of ESD and how its impact might benefit patients in the long term.

GASTRO CON: What was the main limitation of the study?

LMP: First, it was a retrospective study. The patients were allocated to either ESD or EMR depending on the physician’s discretion but were not randomly assigned. Also, the follow-up of the EMR group was longer than the ESD group, which could translate into having a longer time to assess for recurrence.

GASTRO CON: What are the next steps of your research?

LMP: The immediate next step would be to do a cost-effective analysis to compare ESD and EMR. ESD is more expensive because of the special equipment that is required and the time that it takes. However, if more ESD procedures are needed, then those costs might even out later on.

Reference:

Mejia Perez LK, Alaber OA, Jawaid S, et al. Endoscopic submucosal dissection vs. endoscopic mucosal resection for treatment of Barrett’s related superficial esophageal neoplasia [abstract 355]. Am J Gastroenterol. 2019;114(2019 ACG Annual Meeting Abstracts):S209. doi:10.14309/01.ajg.0000590952.19457.8c.