Endoscopic resection with or without mucosal ablation of high grade dysplasia and early oesophageal adenocarcinoma--long term follow up from a regional UK centre

Abstract

Background: Endoscopic resection (ER) is emerging as a curative technique in patients with high-grade dysplasia (HGD), intramucosal cancer (IMC), and early submucosal cancer (T1sm1) within Barrett's oesophagus.

Methods: This consecutive case series of 72 patients with HGD or IMC reports outcomes of ER, with or without mucosal ablation, in a single institution after a median of 38 months follow-up between 2004 and 2011. The primary outcome was disease progression to submucosal invasion. Secondary outcomes included disease regression, the effect of ER on staging compared to biopsy and procedure-related complications.

Results: 72 patients (mean age 73.0 - range 52.0-93.0) were treated by ER ± ablative therapy with curative intent for HGD (88% patients) or IMC (12%). 38% had one or more severe systemic co-morbidities. A median of 4 (1-11) procedures were undertaken per patient. In addition to ER, 43% of patients were treated with argon plasma coagulation, 17% with radiofrequency ablation, and 11% with photodynamic therapy. 8 (13%) patients with HGD at baseline and 0 (0%) with IMC progressed to invasive carcinoma. The median time to progression was 26.3 and 12.6 months respectively. 51% patients experienced disease regression. Disease staging was upgraded by ER in 27% of patients.

Discussion: This case series reports on a minimally invasive technique in an elderly population with multiple co-morbidities, demonstrating disease regression with long-term follow-up.

Conclusion: ER ± ablation is an effective and potentially curative option for patients with HGD or IMC. The benefit of endoscopic resection for disease staging was clearly demonstrated.

Keywords: Adenocarcinoma; Barrett's; Dysplasia; Endoscopic mucosal resection.