World Journal of Surgery

, Volume 38, Issue 1, pp 96–105

Management of Early-stage Esophageal Neoplasia (MESEN) Consensus

  • Alejandro Nieponice
  • Adolfo E. Badaloni
  • Blair A. Jobe
  • Toshitaka Hoppo
  • Carlos Pellegrini
  • Vic Velanovich
  • Gary W. Falk
  • Kevin Reavis
  • Lee Swanstrom
  • Virender K. Sharma
  • Fabio Nachman
  • Franco F. Ciotola
  • Luis E. Caro
  • Cecilio Cerisoli
  • Demetrio Cavadas
  • Luis Durand Figueroa
  • Daniel Pirchi
  • Michael Gibson
  • Santiago Elizalde
  • Henry Cohen
Article

DOI: 10.1007/s00268-013-2235-y

Cite this article as:
Nieponice, A., Badaloni, A.E., Jobe, B.A. et al. World J Surg (2014) 38: 96. doi:10.1007/s00268-013-2235-y

Abstract

Background

Treatment of esophageal adenocarcinoma often involves surgical resection. Newer technologies in interventional endoscopy have led to a substantial paradigm shift in the management of early-stage neoplasia in Barrett’s esophagus comprising high-grade dysplasia (HGD), intramucosal carcinoma, and, in some cases, submucosal carcinoma. However, there has been no consensus regarding the indications for esophageal preservation in these cases. In this work, consensus guidelines were established for the management of early-stage esophageal neoplasia considering clinically relevant aspects (age, comorbidities, and social environment) in each scenario.

Methods

Seventeen experts were invited to participate based on their background and clinical expertise at high-volume centers. A questionnaire was created that included four clinical scenarios covering a wide range of situations within HGD and/or early esophageal neoplasia, particularly where controversies are likely to exist. Each of the clinical scenarios was open to discussion subdivided by patient age (20, 50, and 80 s). For each clinical scenario an expert was chosen to defend that position. Each defense triggered a subsequent discussion during a consensus meeting. Conclusions of that discussion together with an accompanying literature analysis allowed experts to confirm or change their original choices and served as the basis for the recommendations stated in this article.

Results

There was 100 % consensus supporting esophageal preservation in patients with HGD, independent of patient age or Barrett’s length. In patients with T1a adenocarcinoma, consensus for preservation was not reached (65 %) for young and middle-aged individuals but was supported for elderly patients (100 %). For T1b adenocarcinoma, consensus was reached for surgical resection (90 %), leaving organ preservation for patients with very low risk of nodal invasion or poor surgical candidates.

Conclusion

Advances in endoscopic imaging and therapy allow for organ preservation in most settings of early-stage neoplasia of the esophagus, provided that the patient understands the implications of this decision.

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Alejandro Nieponice
    • 1
  • Adolfo E. Badaloni
    • 1
  • Blair A. Jobe
    • 2
  • Toshitaka Hoppo
    • 2
  • Carlos Pellegrini
    • 3
  • Vic Velanovich
    • 4
  • Gary W. Falk
    • 5
  • Kevin Reavis
    • 6
  • Lee Swanstrom
    • 6
  • Virender K. Sharma
    • 7
  • Fabio Nachman
    • 1
  • Franco F. Ciotola
    • 1
  • Luis E. Caro
    • 8
  • Cecilio Cerisoli
    • 8
  • Demetrio Cavadas
    • 9
  • Luis Durand Figueroa
    • 10
  • Daniel Pirchi
    • 11
  • Michael Gibson
    • 12
  • Santiago Elizalde
    • 8
  • Henry Cohen
    • 13
  1. 1.Department of SurgeryUniversity of FavaloroBuenos AiresArgentina
  2. 2.Department of SurgeryWest Penn Allegheny Health SystemPittsburghUSA
  3. 3.Department of SurgeryUniversity of WashingtonSeattleUSA
  4. 4.Department of SurgeryUniversity of South FloridaTampaUSA
  5. 5.Gastroenterology Division, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of SurgeryOregon Center for Clinical InvestigationsPortlandUSA
  7. 7.Gastroenterology UnitArizona Center for Digestive HealthGilbertUSA
  8. 8.Gastroenterology UnitGEDYTBuenos AiresArgentina
  9. 9.Department of SurgeryHospital Italiano de Buenos AiresBuenos AiresArgentina
  10. 10.Department of SurgeryHospital de ClínicasBuenos AiresArgentina
  11. 11.Gastroenterology UnitHospital BritánicoBuenos AiresArgentina
  12. 12.Oncology DivisionUniversity of PittsburghPittsburghUSA
  13. 13.Department of GastroenterologyUniversity of MontevideoMontevideoUruguay

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