Stepwise radical endoscopic resection for Barrett's esophagus with early neoplasia: report on a Brussels' cohort

Background and study aims: The aim of this retrospective study was to assess safety and efficacy of stepwise radical endoscopic resection (SRER) in patients with Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or early cancer. Patients and methods: Patients undergoing SRER between 2000 and 2006 were retrospectively evaluated. Patients with Barrett's esophagus who also had HGIN or early cancer were included if they had no signs of submucosal infiltration or metastases. SRER was performed using the cap-technique, at 8-week intervals until all Barrett's esophagus was removed. Follow-up endoscopy was scheduled every 6 months. Results: A total of 34 patients were included (31 male, mean 67 years, median Barrett's dimensions C1M4). HGIN/early cancer was eradicated in all patients in a median of two endoscopic resection sessions (IQR 1-2 sessions). Twelve patients underwent additional argon plasma coagulation for small islets or an irregular Nine. Barrett's esophagus was eradicated in 28 patients (82%). Complications occurred in 3/34 patients (9%): two perforations, one delayed bleeding. In all, 19 patients (56%) developed dysphagia, which was resolved with dilatation or stent placement. During a median follow-up period of 23 months (IQR 15-41 months), HGIN/early cancer recurred in three patients (9%): two were retreated with endoscopic resection and one patient was referred for curative surgery. Five patients (15%) had recurrence of nondysplastic Barrett's esophagus. At the end of the follow-up period all patients were free of HGIN/early cancer (one patient after surgery), and 23 patients (68%) had complete endoscopic and histological eradication of Barrett's esophagus. Conclusions: SRER resulted in complete eradication of HGIN/early cancer in all patients, and eradication of Barrett's esophagus in a majority of cases. A significant number of patients develop dysphagia, which can be successfully treated endoscopically.