Abstract
Background
The optimal treatment strategy of esophageal high-grade dysplasia (HGD) and superficial adenocarcinoma remains controversial.
Methods
Here, we describe endoscopic, circumferential mucosal-submucosal en-bloc resection of the entire abnormal esophageal epithelium with extracellular matrix (ECM) placement to regenerate neoepithelium and minimize stricture. That procedure was then followed by a laparoscopic fundoplication as a novel esophageal-preserving approach to treat HGD and superficial adenocarcinoma in the face of chronic gastroesophageal reflux disease (GERD).
Conclusions
This approach could be an ideal option as an alternative to esophagectomy in selected patients.
References
Collard JM (2002) High-grade dysplasia in Barrett’s esophagus. The case for esophagectomy. Chest Surg Clin North Am 12:77–92
Sharma P, Dent J, Armstrong D et al (2006) The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 131:1392–1399
Badylak SF, Hoppo T, Nieponice A et al (2011) Esophageal preservation in five male patients after endoscopic inner-layer circumferential resection in the setting of superficial cancer: a regenerative medicine approach with a biologic scaffold. Tissue Eng Part A 17:1643–1650
Ell C, May A, Pech O et al (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10
Pech O, Bollschweiler E, Manner H et al (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254:67–72
Pech O, Behrens A, May A et al (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57:1200–1206
Witteman BP, Foxwell TJ, Monsheimer S et al (2009) Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation. J Gastrointest Surg 13:2104–2112
Voytik-Harbin SL, Brightman AO, Kraine MR et al (1997) Identification of extractable growth factors from small intestinal submucosa. J Cell Biochem 67:478–491
Nieponice A, McGrath K, Qureshi I et al (2009) An extracellular matrix scaffold for esophageal stricture prevention after circumferential EMR. Gastrointest Endosc 69:289–296
Parrilla P, Martinez de Haro LF, Ortiz A et al (2003) Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg 237:291–298
Zehetner J, DeMeester SR, Hagen JA et al (2011) Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma. J Thorac Cardiovasc Surg 141:39–47
Conflict of interest
No conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hoppo, T., Badylak, S.F. & Jobe, B.A. A Novel Esophageal-preserving Approach to Treat High-grade Dysplasia and Superficial Adenocarcinoma in the Presence of Chronic Gastroesophageal Reflux Disease. World J Surg 36, 2390–2393 (2012). https://doi.org/10.1007/s00268-012-1698-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-012-1698-6