Complex early Barrett's neoplasia at 3 Western centers: European Barrett's Endoscopic Submucosal Dissection Trial (E-BEST)

Gastrointest Endosc. 2017 Oct;86(4):608-618. doi: 10.1016/j.gie.2017.01.027. Epub 2017 Jan 31.


Background and aims: Endoscopic submucosal dissection (ESD) is an effective technique to resect early Barrett's neoplasia and has advantages over conventional EMR in that it enables en-bloc resection and accurate histopathologic analysis of cancer resection margins. However, its long learning curve and higher adverse event rate have tempered its uptake in the West. We aimed to analyze the safety and efficacy of ESD when used to resect complex Barrett's neoplasia. The primary endpoint was the en-bloc and R0 resection rate.

Methods: This was a retrospective analysis of 143 ESDs for Barrett's neoplasia performed in 3 tertiary referral centers from 2008 to 2016.

Results: The mean lesion size was 31.1 mm (range, 5-90) and median follow-up time 21.6 months (interquartile range, 11.0-32.6). In total, 24.5% of lesions (35/143) were scarred after previous endoscopic resection, surgery, or radiotherapy. The en-bloc resection rate was 90.8% and R0 resection rate 79% in this series. The overall adverse event rate was 3.5% (1.4% bleeding, 0% perforation, and 2.1% stricture formation). The expanded curative resection rate was 65.8%, reflecting the R0 resection rate and proportion of cases with more advanced disease. Submucosal cancer was identified as a significant factor affecting the R0 resection rate.

Conclusion: We demonstrated the feasibility and safety of ESD in the West for resection of complex Barrett's neoplasia including large, nodular, or scarred lesions. This is a safe and effective technique with a low adverse event rate when performed by an experienced operator. The en-bloc resection rate reached a plateau once 30 procedures had been performed.

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Aged
  • Barrett Esophagus / pathology
  • Barrett Esophagus / surgery*
  • Endoscopic Mucosal Resection / methods*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophageal Stenosis / epidemiology
  • Esophagoscopy / methods*
  • Female
  • Gastrointestinal Hemorrhage / epidemiology
  • Humans
  • Italy
  • Male
  • Margins of Excision
  • Neoplasm Staging
  • Postoperative Complications / epidemiology
  • Postoperative Hemorrhage / epidemiology
  • Precancerous Conditions / pathology
  • Precancerous Conditions / surgery*
  • Retrospective Studies
  • Switzerland
  • United Kingdom