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Single center experience of endoscopic submucosal dissection (ESD) in early Barrett´s adenocarcinoma

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Abstract

Background

Endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett´s adenocarcinoma (EBAC). Endoscopic submucosal dissection (ESD) is a new endoscopic technique, which allows—in contrast to EMR—endoscopic en-bloc resection of neoplastic lesions greater than 2 cm with complete histological evaluation of the resected specimen. In contrast to Western countries, Barrett´s esophagus is less common in Asia indicating the low volume of published data of ESD in EBAC in Japanese series. Therefore, the aim of the present study is to describe the results of ESD in patients with EBAC performed in a German tertiary referral center.

Methods

Between November 2009 and April 2014 ESDs were performed in 22 patients with histologically proven EBAC. Data were given for the en-bloc, the R0, the R0 en-bloc, and the curative resection rate as well as for the complication and the local recurrence rate.

Results

ESD was technically possible in all of the 22 patients. 20 of the resected EBAC were mucosal carcinomas, whereas in two patients the tumor showed submucosal invasion. The en-bloc, R0, R0 en-bloc, and curative resection rates were 95.5, 81.8, 81.8 %, and77.3 %, resp. Complication rate was 27.3 % (perforation n = 1, bleeding n = 2, stenosis n = 3). In case of curative tumor resection, only one local tumor recurrence (5.9 %) occurred after a medium follow-up of 1.6 years.

Conclusions

Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD, especially in case of curative resections in the definite and less invasive therapy of EBAC. Attention should be drawn toward subsquamous extension of EBAC requiring a sufficient safety margin as an obligate condition for curative R0 resections. Due to the required learning curve and the management of potential complications, ESD should be restricted to greater endoscopic centers.

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Disclosure

Dr. P. Dautel, Dr. R. Baumbach, Dr. S. Faiss became speaker honoraria from Olympus Deutschland GmbH (Hamburg, Deutschland). Dr. N. Yahagi became speaker honoraria and honoraria for consultantship from Olympus (Tokyo, Japan). Dr. S. Höbel, Dr. K.-J. Oldhafer, Dr. A. Stang, Dr. B. Feyerabend, Dr. C. Schrader have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology & Interventional Endoscopy; Asklepios Hospital Barmbek, Medical Faculty, Semmelweis University, Campus Hamburg, Rübenkamp 220, 22291, Hamburg, Germany

    S. Höbel, P. Dautel, R. Baumbach, C. Schrader & S. Faiss

  2. Department of Abdominal Surgery; Asklepios Hospital Barmbek, Medical Faculty, Semmelweis University, Campus Hamburg, Rübenkamp 220, 22291, Hamburg, Germany

    K.-J. Oldhafer

  3. Department of Oncology & Palliative Care Medicine; Asklepios Hospital Barmbek, Medical Faculty, Semmelweis University, Campus Hamburg, Rübenkamp 220, 22291, Hamburg, Germany

    A. Stang

  4. MVZ Hanse Histologikum GmbH, Fangdieckstr. 75, 22547, Hamburg, Germany

    B. Feyerabend

  5. Division of Research and Development for Minor Invasive Treatment, Tumor Center, Keio University School of Medicine, Tokyo, Japan

    N. Yahagi

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  1. S. Höbel
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  2. P. Dautel
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  3. R. Baumbach
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  4. K.-J. Oldhafer
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  5. A. Stang
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  6. B. Feyerabend
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  7. N. Yahagi
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  8. C. Schrader
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  9. S. Faiss
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Corresponding author

Correspondence to S. Faiss.

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Höbel, S., Dautel, P., Baumbach, R. et al. Single center experience of endoscopic submucosal dissection (ESD) in early Barrett´s adenocarcinoma. Surg Endosc 29, 1591–1597 (2015). https://doi.org/10.1007/s00464-014-3847-5

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  • DOI: https://doi.org/10.1007/s00464-014-3847-5

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