Surgical Endoscopy

, Volume 30, Issue 12, pp 5330–5337 | Cite as

Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett’s esophagus

  • Ian Holmes
  • Tressia Hing
  • Shai Friedland


Background and aims

Piecemeal endoscopic mucosal resection (EMR) is the standard treatment of nodular Barrett’s esophagus dysplasia and T1a cancer. Piecemeal resection may be incomplete and makes precise histologic assessment difficult. Endoscopic submucosal dissection (ESD) is a technique that enables en-bloc resection but has not gained widespread acceptance due to its technical difficulty, risk and long procedure time.


We developed a protocol consisting of a combination of a limited ESD with supplementary EMR in the same session if necessary, designed to increase en-bloc resection of the most worrisome neoplastic area while maximizing the rate of complete resection of dysplasia. Records of consecutive patients referred for treatment during a 2-year period were reviewed.


Eleven patients were treated: two with ESD and nine with combined ESD/EMR. Eight patients had mucosal lesions; three patients had submucosally invasive cancer and were referred to surgery. Five of the 8 mucosal lesions were removed en-bloc by ESD with dysplasia-free margins. Two patients with T1a cancer had low-grade dysplasia in the ESD margins and removal of all dysplasia on EMR. One patient with T1a cancer had high-grade dysplasia in the ESD margins and on EMR. He required a second endoscopy to remove residual neoplasia. There were no adverse events. The mean procedure time was 66.4 ± 15.1 min.


Combining a limited ESD with EMR in the same session enables efficient treatment of visible dysplastic lesions in Barrett’s esophagus.


Barrett esophagus Esophagus cancer Endoscopic mucosal resection Endoscopic submucosal dissection 



Endoscopic mucosal resection


Endoscopic submucosal dissection


Radiofrequency ablation


Low-grade dysplasia


High-grade dysplasia


Compliance with ethical standards


Ian Holmes, Tressia Hing and Shai Friedland have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2016

Authors and Affiliations

  1. 1.Department of MedicineStanford University School of MedicineStanfordUSA
  2. 2.Department of GastroenterologyStanford University School of MedicineStanfordUSA
  3. 3.VA Palo Alto Health Care SystemPalo AltoUSA

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