Endoscopic management of high-grade dysplasia and intramucosal carcinoma: Experience in a large academic medical center

Kyle A. Perry, Jon P. Walker, Mario Salazar, Andrew Suzo, Jeffrey W. Hazey, W. Scott Melvin

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Esophagectomy has been the standard treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) and intramucosal cancer (IMC). Recently, endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) have become the preferred treatment for these patients in some centers. We report a single institution series of patients undergoing endoscopic management of HGD and IMC. Methods: Nineteen patients underwent endoscopic treatment for HGD or IMC between 2009 and 2012. The primary outcome measure was progression of BE necessitating esophagectomy. Secondary outcomes included complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D), recurrence or progression of BE or dysplasia, and complications. Patients were followed for a median follow-up interval of 19 months following completion of RFA treatment. Results: Three patients (16 %) had a presenting diagnosis of IMC, and 16 (84 %) were treated for HGD. Twelve (63 %) had long-segment BE; the median length of BE was 5 cm. Ten (53 %) patients underwent EMR prior to RFA. CE-D was achieved in 88 % of patients, and CE-IM was achieved in 65 % of patients. A median of 2 (1-7) treatments were required, and there were no immediate post-procedure complications. Two patients developed recurrent dysplasia following complete eradication of BE, and each case was successfully managed with repeat RFA. Three patients (16 %) required esophagectomy within 6 months following RFA. A complete surgical resection was achieved in each case, and none of the patients developed lymph node metastases. Conclusions: Complete eradication of HGD and IMC can be achieved via endoscopic therapy, thus avoiding esophagectomy in the majority of patients. However, a subset of patients will fail this treatment approach and will require surgical resection. With aggressive endoscopic treatment and surveillance, these patients can be identified at an early stage while curative resection is still possible.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume28
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Carcinoma
Barrett Esophagus
Esophagectomy
Metaplasia
Therapeutics
Neoplasms
Lymph Nodes
Outcome Assessment (Health Care)
Neoplasm Metastasis
Recurrence

Keywords

  • Barrett's esophagus
  • Endoscopic mucosal resection
  • Esophageal cancer
  • High-grade dysplasia
  • Radiofrequency ablation
  • Therapeutic endoscopy

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Endoscopic management of high-grade dysplasia and intramucosal carcinoma : Experience in a large academic medical center. / Perry, Kyle A.; Walker, Jon P.; Salazar, Mario; Suzo, Andrew; Hazey, Jeffrey W.; Melvin, W. Scott.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 28, No. 3, 2014, p. 777-782.

Research output: Contribution to journalArticle

Perry, Kyle A. ; Walker, Jon P. ; Salazar, Mario ; Suzo, Andrew ; Hazey, Jeffrey W. ; Melvin, W. Scott. / Endoscopic management of high-grade dysplasia and intramucosal carcinoma : Experience in a large academic medical center. In: Surgical Endoscopy and Other Interventional Techniques. 2014 ; Vol. 28, No. 3. pp. 777-782.
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abstract = "Background: Esophagectomy has been the standard treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) and intramucosal cancer (IMC). Recently, endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) have become the preferred treatment for these patients in some centers. We report a single institution series of patients undergoing endoscopic management of HGD and IMC. Methods: Nineteen patients underwent endoscopic treatment for HGD or IMC between 2009 and 2012. The primary outcome measure was progression of BE necessitating esophagectomy. Secondary outcomes included complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D), recurrence or progression of BE or dysplasia, and complications. Patients were followed for a median follow-up interval of 19 months following completion of RFA treatment. Results: Three patients (16 {\%}) had a presenting diagnosis of IMC, and 16 (84 {\%}) were treated for HGD. Twelve (63 {\%}) had long-segment BE; the median length of BE was 5 cm. Ten (53 {\%}) patients underwent EMR prior to RFA. CE-D was achieved in 88 {\%} of patients, and CE-IM was achieved in 65 {\%} of patients. A median of 2 (1-7) treatments were required, and there were no immediate post-procedure complications. Two patients developed recurrent dysplasia following complete eradication of BE, and each case was successfully managed with repeat RFA. Three patients (16 {\%}) required esophagectomy within 6 months following RFA. A complete surgical resection was achieved in each case, and none of the patients developed lymph node metastases. Conclusions: Complete eradication of HGD and IMC can be achieved via endoscopic therapy, thus avoiding esophagectomy in the majority of patients. However, a subset of patients will fail this treatment approach and will require surgical resection. With aggressive endoscopic treatment and surveillance, these patients can be identified at an early stage while curative resection is still possible.",
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T1 - Endoscopic management of high-grade dysplasia and intramucosal carcinoma

T2 - Experience in a large academic medical center

AU - Perry, Kyle A.

AU - Walker, Jon P.

AU - Salazar, Mario

AU - Suzo, Andrew

AU - Hazey, Jeffrey W.

AU - Melvin, W. Scott

PY - 2014

Y1 - 2014

N2 - Background: Esophagectomy has been the standard treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) and intramucosal cancer (IMC). Recently, endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) have become the preferred treatment for these patients in some centers. We report a single institution series of patients undergoing endoscopic management of HGD and IMC. Methods: Nineteen patients underwent endoscopic treatment for HGD or IMC between 2009 and 2012. The primary outcome measure was progression of BE necessitating esophagectomy. Secondary outcomes included complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D), recurrence or progression of BE or dysplasia, and complications. Patients were followed for a median follow-up interval of 19 months following completion of RFA treatment. Results: Three patients (16 %) had a presenting diagnosis of IMC, and 16 (84 %) were treated for HGD. Twelve (63 %) had long-segment BE; the median length of BE was 5 cm. Ten (53 %) patients underwent EMR prior to RFA. CE-D was achieved in 88 % of patients, and CE-IM was achieved in 65 % of patients. A median of 2 (1-7) treatments were required, and there were no immediate post-procedure complications. Two patients developed recurrent dysplasia following complete eradication of BE, and each case was successfully managed with repeat RFA. Three patients (16 %) required esophagectomy within 6 months following RFA. A complete surgical resection was achieved in each case, and none of the patients developed lymph node metastases. Conclusions: Complete eradication of HGD and IMC can be achieved via endoscopic therapy, thus avoiding esophagectomy in the majority of patients. However, a subset of patients will fail this treatment approach and will require surgical resection. With aggressive endoscopic treatment and surveillance, these patients can be identified at an early stage while curative resection is still possible.

AB - Background: Esophagectomy has been the standard treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) and intramucosal cancer (IMC). Recently, endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) have become the preferred treatment for these patients in some centers. We report a single institution series of patients undergoing endoscopic management of HGD and IMC. Methods: Nineteen patients underwent endoscopic treatment for HGD or IMC between 2009 and 2012. The primary outcome measure was progression of BE necessitating esophagectomy. Secondary outcomes included complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D), recurrence or progression of BE or dysplasia, and complications. Patients were followed for a median follow-up interval of 19 months following completion of RFA treatment. Results: Three patients (16 %) had a presenting diagnosis of IMC, and 16 (84 %) were treated for HGD. Twelve (63 %) had long-segment BE; the median length of BE was 5 cm. Ten (53 %) patients underwent EMR prior to RFA. CE-D was achieved in 88 % of patients, and CE-IM was achieved in 65 % of patients. A median of 2 (1-7) treatments were required, and there were no immediate post-procedure complications. Two patients developed recurrent dysplasia following complete eradication of BE, and each case was successfully managed with repeat RFA. Three patients (16 %) required esophagectomy within 6 months following RFA. A complete surgical resection was achieved in each case, and none of the patients developed lymph node metastases. Conclusions: Complete eradication of HGD and IMC can be achieved via endoscopic therapy, thus avoiding esophagectomy in the majority of patients. However, a subset of patients will fail this treatment approach and will require surgical resection. With aggressive endoscopic treatment and surveillance, these patients can be identified at an early stage while curative resection is still possible.

KW - Barrett's esophagus

KW - Endoscopic mucosal resection

KW - Esophageal cancer

KW - High-grade dysplasia

KW - Radiofrequency ablation

KW - Therapeutic endoscopy

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