Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Management of Early Esophageal Neoplasia: an Emerging Standard

  • SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Endoscopic mucosal resection (EMR) and ablation technologies have markedly changed the treatment of early esophageal neoplasia. We analyzed treatment and outcomes of patients undergoing multimodal endoscopic treatment of early esophageal neoplasia at our institution.

Methods

Records of patients undergoing endoscopic treatment for esophageal low-grade intraepithelial neoplasia (LGIN, n = 11), high-grade intraepithelial neoplasia (HGIN, n = 24), or T1N0M0 neoplasia (n = 10), presenting between 2007 and 2009, were reviewed. Outcomes included eradication of neoplasia/intestinal metaplasia, development of metachronous neoplasia, and progression to surgical resection.

Results

There were 45 patients, 96% male, with a mean age 67 years. The degree of neoplasia prior to intervention was intramucosal (8) or submucosal (2) carcinoma in 10, HGIN in 24, and LGIN in 11. Patients underwent a total of 166 procedures (median 3/patient, range 1–9). These included 120 radiofrequency ablation sessions, 38 EMRs, and 8 cryoablations. Mean follow-up was 21.3 months. Neoplasia and intestinal metaplasia were eradicated in 87.2% and 56.4% of patients, respectively, while 15.4% developed metachronous neoplasia. Three patients underwent esophagectomy. No patient developed unresectable disease or died.

Conclusion

Endoscopic treatment of early esophageal neoplasia is safe and effective in the short term. A minority of treated patients developed recurrent neoplasia, which is usually amenable to further endoscopic therapy. Complications are relatively minor and uncommon. Endoscopic therapy as the initial treatment for early esophageal neoplasia is an emerging standard of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Heitmiller RF, Redmond M, Hamilton SR. Barrett’s Esophagus with High-Grade Dysplaisa: An Indication for Prophylactic Esophagectomy. Annals of Surgery 1996; 224 (1): 66–71.

    Article  PubMed  CAS  Google Scholar 

  2. Williams, VA, Watson TJ, Herbella FA, Gellersen O, Raymond D, Jones C, Peters JH. Esophagectomy for High Grade Dysplasia is Safe, Curative and Results in Good Alimentary Outcome. J Gastrointest Surg 2007; 11:1589–1597.

    Article  PubMed  Google Scholar 

  3. Inoue H, Endo M, Takeshita K, Muraoka Y, Yoneshima H. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope. Surg Endosc 1992; 6(5):264–265.

    Article  PubMed  CAS  Google Scholar 

  4. Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, Jobe BA, Eisen GM, Fennerty MB, Hunter JG, Fleisher DE, Sharma VK, Hawes RH, Hoffman BJ, Rothstein RI, Gordon SR, Mashimo H, Chang KJ, Muthusamy VR, Edmundowics SA, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Falk GW, Kimmey MB, Madanick RD, Chak A, Lightdale CJ. Radiofrequiency Ablation in Barrett's Esophagus with Dysplasia. New Engl J Med 2009; 360:2277–2288.

    Article  PubMed  CAS  Google Scholar 

  5. Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C. 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 2008; 57; 1200–1206.

    Article  PubMed  CAS  Google Scholar 

  6. Pouw RE, Gondrie JJ, Sondermeijer CM, ten Kate FJ, van Julik RM, Krishnadath KK, Fockens P, Weusten BL, Bergman JJ. Eradication of Barrett Esophagus with Early Neoplasia by Radiofrequency Ablation, with or without Endoscopic Resection. J Gastrointest Surg 2008; 12:1627–1637.

    Article  PubMed  Google Scholar 

  7. Badreddine RJ, Prasad GA, Wang KK, Song LM, Buttar NS, Dunagan KT, Lutzke LS, Borkenhagen LS. Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus. Gastrointest Endosc 2010; 71(4):697–703.

    Article  PubMed  Google Scholar 

  8. Sharma VK, Jae Kim H, Das A, Wells CD, Nguyen CC, Fleischer DE. Circumferential and Focal Ablation of Barrett's Esophagus Containing Dysplasia. Am J Gastroenterol 2009; 104:310–317.

    Article  PubMed  Google Scholar 

  9. Dumot JA, Vargo II JJ, Falk GW, Frey L, Lopez R, Rice TW. An open-label, prospective trial of cryospray ablation for Barrett's esophagus high-grade dysplasia and early esophageal cancer in hight-risk patients. Gastrointestinal Endoscopy 2009; 70(4):634–44.

    Article  Google Scholar 

  10. Sharma VK, Wang KK, Overholt BF, et al. Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients. Gastrointest Endosc 2009; 65(2):185–195.

    Article  Google Scholar 

  11. Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, Freeman SR, Pruitt RE, Urayama SM, Gress F, Pavey DA, Branch MS, Savides TJ, Chang KJ, Muthusamy VR, Bohorfoush AG, Pace SC, DeMeester SR, Eysselein VE, Panjehpour M, Triadafilopoulos G. U.S. Multicenter Registry. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointestinal Endoscopy 2008; 68(1):35–40.

    Article  PubMed  Google Scholar 

  12. Velanovich V. Endoscopic endoluminal radiofrequency ablation of Barrett's esophagus: initial results and lessons learned. Surg Endosc 2009;23:2175–2180.

    Article  PubMed  Google Scholar 

  13. Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest Endosc 2007;65:3–10.

    Article  PubMed  Google Scholar 

  14. Prasad GA. Wu TT. Wigle DA. Buttar NS. Wongkeesong LM. Dunagan KT. Lutzke LS. Borkenhagen LS. Wang KK. Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett's esophagus. Gastroenterology 2009;137(3):815–23.

    Article  PubMed  Google Scholar 

  15. Chennat J, Konda VJA, Ross AS, Herreros de Tejada A, Noffsinger A, Hart J, Lin S, Ferguson MK, Posner MC, Waxman I. Complete Barrett's Eradication Endoscopic Mucosal Resection: An Effective Treatment Modality for High-Grade Dysplasia and Intramucosal Carcinoma- An American Single-Center Experience. Am J Gastroenterol 2009;104:2684–2692.

    Article  PubMed  Google Scholar 

  16. Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, Bohmer C, Mallant-Hent RC, Oijen AV, Naber AH Scholten P, Busch OR, Blaauwgeers HGT, Meijer GA, Bergman JGHM. Low-Grade Dysplasia in Barrett's Esophagus: Overdiagnosed and Underestimated. Am J Ganstroenterol 2010;105:1523–1530.

    Article  Google Scholar 

  17. Shaheen NJ, Greenwald BD, Peery AF, Dumot JA, Nishioka NS, Wolfsen HC, Burdick JS, Abrams JA, Wang KK, Mallat D, Johnston MH, Zfass AM, Smith JO, Barthel JS, Lightdale CJ. Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia. Gastrointest Endosc 2010;71(4):680–685.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA

    Kelly M Galey, Candice L Wilshire, Thomas J Watson, Marabel D Schneider, Carolyn E Jones, Virginia R Litle & Jeffrey H Peters

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Vivek Kaul & Asad Ullah

  3. Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, NY, 14642, USA

    Jeffrey H Peters

Authors
  1. Kelly M Galey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Candice L Wilshire
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas J Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marabel D Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vivek Kaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carolyn E Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Virginia R Litle
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Asad Ullah
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jeffrey H Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey H Peters.

Additional information

This research was presented at the DDW Poster Session, May 3, 2010.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Galey, K.M., Wilshire, C.L., Watson, T.J. et al. Endoscopic Management of Early Esophageal Neoplasia: an Emerging Standard. J Gastrointest Surg 15, 1728–1735 (2011). https://doi.org/10.1007/s11605-011-1618-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1618-3

Keywords

Search

Navigation