Surgical Endoscopy

, Volume 25, Issue 2, pp 543–548

Endoscopic mucosal resection for gastroesophageal cancer in a U.K. population. Long-term follow-up of a consecutive series

  • Andrew B. C. Crumley
  • James J. Going
  • Kerryanne McEwan
  • Margaret McKernan
  • Jo-Etienne Abela
  • Christopher J. Shearer
  • Adrian J. Stanley
  • Robert C. Stuart



Endoscopic mucosal resection (EMR) of early gastric and esophageal tumors is effective and avoids the morbidity and mortality of surgery. We report the long-term results of a consecutive series of 93 endoscopic resections, during a 7-year period, in a U.K. population.


Eighty-eight patients with 93 lesions were included. EMR was performed for 64 and 29 malignant and benign lesions, respectively. Patients with malignant disease were subgrouped into “high risk” or “low risk” for recurrence.


Of the 35 lesions in the low-risk group, local control was achieved in 31; 29 after 1 EMR session. Two had residual invasive carcinoma, one had treatment ceased due to pancreatic cancer, and one patient did not attend follow-up. Of the 29 lesions in the high-risk group, local control was achieved in 15; 13 after 1 EMR session. Median follow-up was 53 months. Cancer specific survival for the 45 invasive cancers (T1m and T1sm) was 93%; three patients died from their disease.


This study has shown for the first time in a U.K. population that EMR is effective in controlling disease in patients with local high grade dysplasia (HGD) and early invasive carcinoma, with no mortality and low morbidity.


Gastric Esophageal Cancer Barrett’s Endoscopy 


  1. 1.
    Cancer Stats (2004).
  2. 2.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMedGoogle Scholar
  3. 3.
    Takeshita K, Tani M, Inoue H, Saeki I, Hayashi S, Honda T, Kando F, Saito N, Endo M (1997) Endoscopic treatment of early oesophageal or gastric cancer. Gut 40:123–127PubMedGoogle Scholar
  4. 4.
    Ell C, May A, Gossner L, Pech O, Gunter E, Mayer G, Henrich R, Vieth M, Muller H, Seitz G, Stolte M (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118:670–677CrossRefPubMedGoogle Scholar
  5. 5.
    Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10CrossRefPubMedGoogle Scholar
  6. 6.
    Conio M, Repici A, Cestari R, Blanchi S, Lapertosa G, Missale G, Della CD, Villanacci V, Calandri PG, Filiberti R (2005) Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett’s esophagus: an Italian experience. World J Gastroenterol 11:6650–6655PubMedGoogle Scholar
  7. 7.
    Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (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(9):1200–1206 (Epub 2008 May 6)CrossRefPubMedGoogle Scholar
  8. 8.
    Larghi A, Lightdale CJ, Ross AS, Fedi P, Hart J, Rotterdam H, Noffsinger A, Memeo L, Bhagat G, Waxman I (2007) Long-term follow-up of complete Barrett’s eradication endoscopic mucosal resection (CBE-EMR) for the treatment of high grade dysplasia and intramucosal carcinoma. Endoscopy 39(12):1086–1091 (Epub 2007 Aug 15)CrossRefPubMedGoogle Scholar
  9. 9.
    Lopes CV, Hela M, Pesenti C, Bories E, Caillol F, Monges G, Giovannini M (2007) Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma. Surg Endosc 21:820–824CrossRefPubMedGoogle Scholar
  10. 10.
    Ahmad NA, Kochman ML, Long WB, Furth EE, Ginsberg GG (2002) Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 55:390–396CrossRefPubMedGoogle Scholar
  11. 11.
    Tseng EE, Wu TT, Yeo CJ, Heitmiller RF (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome—an update. J Gastrointest Surg 7:164–170CrossRefPubMedGoogle Scholar
  12. 12.
    Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232(6):733–742CrossRefPubMedGoogle Scholar
  13. 13.
    Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Peters JH, Oberg S, Theisen J, Kiyabu M, Crookes PF, Bremner CG (1999) Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 117(1):16–23CrossRefPubMedGoogle Scholar
  14. 14.
    Migliore M, Choong CK, Lim E, Goldsmith KA, Ritchie A, Wells FC (2007) A surgeon’s case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg 32:375–380CrossRefPubMedGoogle Scholar
  15. 15.
    Clinical Research and Audit Group (CRAG) (2002) Scottish audit of gastric and oesophageal cancer: report 1997–2000. CRAG, Edinburgh.
  16. 16.
    Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39(1):58–62CrossRefPubMedGoogle Scholar
  17. 17.
    Dehyle P, Largiader F, Jenny S (1973) A method for endoscopic electroresection of sessile colonic polyps. Endoscopy 5:38–40CrossRefGoogle Scholar
  18. 18.
    Martin TR, Onstad GR, Silvis SE, Vennes JA (1976) Lift and cut biopsy technique for submucosal sampling. Gastrointest Endosc 23(1):29–30CrossRefPubMedGoogle Scholar
  19. 19.
    Soehendra N, Binmoeller KF, Bohnacker S, Seitz U, Brand B, Thonke F, Gurakuqi G (1997) Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 29(5):380–383CrossRefPubMedGoogle Scholar
  20. 20.
    Chaves DM, Sakai P, Mester M, Spinosa SR, Tomishige T, Ishioka S (1994) A new endoscopic technique for the resection of flat polypoid lesions. Gastrointest Endosc 40(2 Pt 1):224–226CrossRefPubMedGoogle Scholar
  21. 21.
    Fleischer DE, Wang GQ, Dawsey S, Tio TL, Newsome J, Kidwell J, Prifti S (1996) Tissue band ligation followed by snare resection (band and snare): a new technique for tissue acquisition in the esophagus. Gastrointest Endosc 44(1):68–72CrossRefPubMedGoogle Scholar
  22. 22.
    May A, Gossner L, Behrens A, Kohnen R, Vieth M, Stolte M, Ell C (2003) A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus. Gastrointest Endosc 58(2):167–175CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Andrew B. C. Crumley
    • 1
  • James J. Going
    • 2
  • Kerryanne McEwan
    • 2
  • Margaret McKernan
    • 1
  • Jo-Etienne Abela
    • 1
  • Christopher J. Shearer
    • 1
  • Adrian J. Stanley
    • 3
  • Robert C. Stuart
    • 1
  1. 1.University Department of SurgeryRoyal InfirmaryGlasgowUK
  2. 2.University Department of PathologyRoyal InfirmaryGlasgowUK
  3. 3.University Department of MedicineRoyal InfirmaryGlasgowUK

Personalised recommendations