Affiliation:
1. Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
Abstract
Abstract
Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are effective treatments for Barrett’s neoplasia. However, little is known about recurrence rates following these techniques. We compared long-term neoplasia recurrence rates following EMR and ESD.
Methods This study included patients with Barrett’s neoplasia (high grade dysplasia/adenocarcinoma) treated between July 2019 and December 2023 at a tertiary referral center in Canada. Outcomes were residual neoplasia at first follow-up, complete remission of neoplasia (CRN), and neoplasia recurrence following CRN.
Results 157 patients were included (87 EMR, 70 ESD). Compared
with EMR, the ESD group had larger lesions (median 2 vs. 3 cm, P<0.05), more adenocarcinoma
(85.1% vs. 94.3%, P = 0.07), and deeper submucosal invasion (T1a: 71.6% vs. 75.8%; T1b-SM1:
25.7% vs. 6.1%; T1b≥SM2: 2.7% vs. 18.2%; P<0.05). Among 124 patients with follow-up (71
EMR, 53 ESD), 84.9% of ESD-treated patients had curative resections (i.e. R0 resection with
low risk for lymph node metastasis), whereas 94.4% of EMR-treated patients had deep margin R0
resection of low risk lesions. At first follow-up, residual neoplasia (14.1% vs. 11.3%) and
CRN (97.2% vs. 100%) were similar in the EMR and ESD groups, but neoplasia recurrence
following CRN was significantly higher with EMR (13% vs. 1.9%, P<0.05), with cumulative
probability of recurrence at 3 years of 18.3% vs. 4.2%, respectively.
Conclusions Neoplasia recurrence following CRN was significantly higher following EMR compared with ESD, suggesting that ESD may be superior to EMR in preventing neoplasia recurrence in Barrett’s esophagus.