Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

INTRODUCTION: The introduction of endoscopic mucosal resection (EMR) and mucosal ablation technologies has markedly changed the treatment options for early esophageal neoplasia. Assessment of success is largely from 2-3 uniquely high volume centers. Our aim was to evaluate the treatment outcome of a cohort of patients undergoing multimodal endoscopic treatment of early esophageal neoplasia. METHODS: The study population included 29 patients treated between 1/07 and 9/09. The degree of neoplasia was low grade dysplasia in 2, high grade dysplasia (HGD) in 21 and adenocarcinoma in 6 (4 intramucosal and 2 beyond the mucosa). Average length of the Barrett’s segment was 4.2cm (range 1-13cm). 103 procedures were performed in 29 patients (28 EMRs, 72 radiofrequency ablations, and 3 cryoablations). Average number of procedures per patient was 3.6 (range 1-13). Median follow up was 15 months (range 3.9-33.9 months) from the time of first intervention. Endoscopic assessment of residual/recurrent disease was performed every 3 months following completion of active therapy. A complete response (CR) was defined as two consecutive biopsies without dysplasia. Disease was defined as metachronous if biopsy demonstrated HGD or adenocarcinoma after CR was achieved. RESULTS: Eighty-nine percent (17/19) of patients achieved CR. Median time to CR was 7.1 months. Three patients (10%) developed metachronous HGD: 2 patients achieved secondary CR and the third is continuing endoscopic therapy. Two patients (7%) with intramucosal carcinoma had EMR specimens with tumor involvement of the deep margin. One underwent esophagectomy for a T1aN0M0 tumor, and the second chose to continue endoscopic therapy. Two patients (7%) with HGD had disease progression: one moderate surgical risk patient who developed invasive adenocarcinoma and chose to continue with endoscopic therapy and the second a high risk surgical candidate who developed intramucosal carcinoma. Both have since had CR. Four patients (14%) developed complications: chest pain requiring admission (2); stricture requiring dilation (1); and nausea/vomiting requiring admission (1). No patient had progression to unresectable disease, nor have there been any deaths. CONCLUSIONS: Endoscopic treatment of early esophageal neoplasia is safe and effective in the vast majority of patients in the short term. Complications are uncommon and relatively minor. A small proportion will develop recurrent neoplasia which is usually amenable to repeat endoscopic therapy. Endoscopic therapy for early esophageal neoplasia is indeed an emerging standard of care.