Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation

Author:

Mesureur Lauriane1,Deprez Pierre H.2ORCID,Bisschops Raf3ORCID,Pouw Roos E.4,Weusten Bas L.A.M.,Barret Maximilien5,Dewint Pieter6,Tate David7,Leclercq Philippe8,Seewald Stefan9,Barbaro Federico10,Baldaque-Silva Francisco11ORCID,Omae Masami11,Pioche Mathieu12,Figueiredo Ferreira Mariana1,Bourke Michael J.13,Haidry Rehan14,Snauwaert Christophe15,Eisendrath Pierre1,De Maertelaer Viviane16,Rosewick Nicolas17,Devière Jacques1,Lemmers Arnaud1ORCID

Affiliation:

1. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

2. Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

3. Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Leuven, Leuven, Belgium

4. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, Netherlands

5. Department of Gastroenterology, Cochin University Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France

6. Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, AZ Maria-Middelares, Ghent, Belgium

7. Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium

8. Department of Gastroenterology, Clinique CHC MontLégia, Liège, Belgium

9. Gastroenterology Center, Klinik Hirslanden, Zurich, Switzerland

10. Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy

11. Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

12. Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

13. Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

14. Department of Gastroenterology, University College London Hospital (UCLH), London, United Kingdom of Great Britain and Northern Ireland

15. Department of Hepatology and Gastroenterology, Sint-Jan Hospital, Bruges, Belgium

16. Institute of Interdisciplinary Research (IRIBHM), Statistical Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium

17. Laboratory of Experimental Gastroenterology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libre de Bruxelles (ULB), Brussels, Belgium

Abstract

Abstract Background This study evaluated the safety and efficacy of salvage endoscopic submucosal dissection (ESD) for Barrett’s neoplasia recurrence after radiofrequency ablation (RFA). Methods Data from patients at 16 centers were collected for a multicenter retrospective study. Patients who underwent at least one RFA treatment for Barrett’s esophagus and thereafter underwent further esophageal ESD for neoplasia recurrence were included. Results Data from 56 patients who underwent salvage ESD between April 2014 and November 2022 were collected. Immediate complications included one muscular tear (1.8%) treated with stent (Agree classification: grade IIIa). Two transmural perforations (3.6%; treated with clips) and five muscular tears (8.9%; two treated with clips) had no clinical impact and were not considered as adverse events. Seven patients (12.5%) developed strictures (grade IIIa), which were treated with balloon dilation. Histological analysis showed 36 adenocarcinoma, 17 high grade dysplasia, and 3 low grade dysplasia. En bloc and R0 resection rates were 89.3% and 66.1%, respectively. Resections were curative in 33 patients (58.9%), and noncurative in 22 patients (39.3%), including 11 “local risk” (19.6%) and 11 “high risk” (19.6%) resections. At the end of follow-up with a median time of 14 (0–75) months after salvage ESD, and with further endoscopic treatment if necessary (RFA, argon plasma coagulation, endoscopic mucosal resection, ESD), neoplasia remission ratio was 37/53 (69.8%) and the median remission time was 13 (1–75) months. Conclusion In expert hands, salvage ESD was a safe and effective treatment for recurrence of Barrett’s neoplasia after RFA treatment.

Publisher

Georg Thieme Verlag KG

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