Endoscopic mucosal resection for early esophageal carcinoma is effective and safe but necessitates continued surveillanc
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IGINAL ARTICLE
Endoscopic mucosal resection for early esophageal carcinoma is effective and safe but necessitates continued surveillance Y. Hasan 1
&
A. R. Murali 1 & H. Gerke 1
Received: 2 May 2020 / Accepted: 27 July 2020 / Published online: 17 November 2020 # Indian Society of Gastroenterology 2020
Abstract Background Endoscopic mucosal resection (EMR) is used for the treatment of early esophageal cancer (EEC). Methods This a retrospective study aimed to study the efficacy, safety, and the recurrence rate of EEC following EMR. Results Seventy-nine patients who had undergone EMR for early EEC (T1a andT1b lesions) from 2006 to 2015 were included. EMR alone was considered curative in 51 patients who had T1a lesion. Complete remission was achieved in 50 (98%) patients. Mean number of sessions of EMR was 1.14. Cancer recurred locally in 6 (12%) of 50 patients at a median follow-up of 48 (18-72) months. Endoscopic treatment alone achieved complete remission at last follow up in 47 of 50 patients (94%) who had initial EMR with complete remission, or in 47 of all 51 patients (92%) in whom EMR was considered curative for EC. The KaplanMeier cancer-free survival following complete remission with EMR was 94.2% at 1 year and 88.4% at 5 years. Patients with complete eradication of Barrett’s had lower risk of recurrence of adenocarcinoma (AC) compared with patients who had persistent Barrett’s (p = 0.01). EMR alone was not considered curative in 19 patients, 16 with T1b AC and 3 with T1a squamous cell carcinoma (SCC) invading the muscularis mucosa (m3). Two major adverse events were noted: delayed bleeding requiring hospitalization, and perforation that was closed endoscopically. Conclusion EMR is effective and safe for the management of early EC. The risk of cancer recurrence, albeit small, warrants surveillance. Complete eradication of Barrett’s should be attempted in all patients after EMR of AC. Keywords Barrett’s esophagus . Buried Barrett’s glands . Endoscopic mucosal resection . Endoscopic sumucosal dissection . Esophagus . Gastroesophageal reflux disease . Recurrence of esophageal carcinoma . Squamous cell cancer . Surveillance
Introduction Esophageal carcinoma remains an important cause of morbidity and mortality worldwide. While squamous cell carcinoma (SCC) remains the most common esophageal cancer worldwide, esophageal adenocarcinoma (AC) is the most common esophageal cancer in the Western countries, and its incidence is increasing in the USA [1]. Current guidelines recommend screening and surveillance of patients with Barrett’s esophagus to decrease the risk of progression to AC [2]. This has led
* Y. Hasan [email protected] 1
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, USA
to an increased identification of patients with early esophageal carcinoma (T1a—carcinoma confined to the mucosa and T1b—carcinoma confined to the submucosa). In the past, esophagectomy has been the primary treatment modali
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