Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

Sanne N van Munster; Eva P D Verheij; Esther A Nieuwenhuis; Johan G J A Offerhaus; Sybren L Meijer; Lodewijk A A Brosens; Bas L A M Weusten; Alaa Alkhalaf; Ed B E Schenk; Erik J Schoon; Wouter L Curvers; Laurelle van Tilburg; Steffi E M van de Ven; Thjon J Tang; Wouter B Nagengast; Martin H M G Houben; Kees C A Seldenrijk; Jacques J G H M Bergman; Arjun D Koch; Roos E Pouw; Dutch Barrett Expert Centers

doi:10.1055/a-1658-7554

Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

Sanne N van Munster, Eva P D Verheij, Esther A Nieuwenhuis, Johan G J A Offerhaus, Sybren L Meijer, Lodewijk A A Brosens, Bas L A M Weusten, Alaa Alkhalaf, Ed B E Schenk, Erik J Schoon, Wouter L Curvers, Laurelle van Tilburg, Steffi E M van de Ven, Thjon J Tang, Wouter B Nagengast, Martin H M G Houben, Kees C A Seldenrijk, Jacques J G H M Bergman^*, Arjun D Koch, Roos E PouwDutch Barrett Expert Centers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands.

METHODS: Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.

RESULTS: 130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90-180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %-92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %-60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.

CONCLUSION: In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.

Original language	English
Pages (from-to)	531-541
Number of pages	11
Journal	Endoscopy
Volume	54
Issue number	06
Early online date	30 Sept 2021
DOIs	https://doi.org/10.1055/a-1658-7554
Publication status	Published - Jun 2022

Keywords

BENCHMARK QUALITY CRITERIA
LYMPH-NODE METASTASIS
EARLY ADENOCARCINOMA
ESOPHAGUS
RESECTION
RISK
MANAGEMENT
DYSPLASIA
INVASION

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van Munster, S. N., Verheij, E. P. D., Nieuwenhuis, E. A., Offerhaus, J. G. J. A., Meijer, S. L., Brosens, L. A. A., Weusten, B. L. A. M., Alkhalaf, A., Schenk, E. B. E., Schoon, E. J., Curvers, W. L., van Tilburg, L., van de Ven, S. E. M., Tang, T. J., Nagengast, W. B., Houben, M. H. M. G., Seldenrijk, K. C. A., Bergman, J. J. G. H. M., Koch, A. D., ... Dutch Barrett Expert Centers (2022). Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures. Endoscopy, 54(06), 531-541. https://doi.org/10.1055/a-1658-7554

@article{97e3288e04e74ad993a52c3eb36e7e15,

title = "Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures",

abstract = "BACKGROUND: The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands.METHODS: Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.RESULTS: 130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90-180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %-92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %-60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.CONCLUSION: In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.",

keywords = "BENCHMARK QUALITY CRITERIA, LYMPH-NODE METASTASIS, EARLY ADENOCARCINOMA, ESOPHAGUS, RESECTION, RISK, MANAGEMENT, DYSPLASIA, INVASION",

author = "{van Munster}, {Sanne N} and Verheij, {Eva P D} and Nieuwenhuis, {Esther A} and Offerhaus, {Johan G J A} and Meijer, {Sybren L} and Brosens, {Lodewijk A A} and Weusten, {Bas L A M} and Alaa Alkhalaf and Schenk, {Ed B E} and Schoon, {Erik J} and Curvers, {Wouter L} and {van Tilburg}, Laurelle and {van de Ven}, {Steffi E M} and Tang, {Thjon J} and Nagengast, {Wouter B} and Houben, {Martin H M G} and Seldenrijk, {Kees C A} and Bergman, {Jacques J G H M} and Koch, {Arjun D} and Pouw, {Roos E} and {Dutch Barrett Expert Centers}",

year = "2022",

month = jun,

doi = "10.1055/a-1658-7554",

language = "English",

volume = "54",

pages = "531--541",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "06",

}

van Munster, SN, Verheij, EPD, Nieuwenhuis, EA, Offerhaus, JGJA, Meijer, SL, Brosens, LAA, Weusten, BLAM, Alkhalaf, A, Schenk, EBE, Schoon, EJ, Curvers, WL, van Tilburg, L, van de Ven, SEM, Tang, TJ, Nagengast, WB, Houben, MHMG, Seldenrijk, KCA, Bergman, JJGHM, Koch, AD, Pouw, RE & Dutch Barrett Expert Centers 2022, 'Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures', Endoscopy, vol. 54, no. 06, pp. 531-541. https://doi.org/10.1055/a-1658-7554

TY - JOUR

T1 - Extending treatment criteria for Barrett's neoplasia

T2 - results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

AU - van Munster, Sanne N

AU - Verheij, Eva P D

AU - Nieuwenhuis, Esther A

AU - Offerhaus, Johan G J A

AU - Meijer, Sybren L

AU - Brosens, Lodewijk A A

AU - Weusten, Bas L A M

AU - Alkhalaf, Alaa

AU - Schenk, Ed B E

AU - Schoon, Erik J

AU - Curvers, Wouter L

AU - van Tilburg, Laurelle

AU - van de Ven, Steffi E M

AU - Tang, Thjon J

AU - Nagengast, Wouter B

AU - Houben, Martin H M G

AU - Seldenrijk, Kees C A

AU - Bergman, Jacques J G H M

AU - Koch, Arjun D

AU - Pouw, Roos E

AU - Dutch Barrett Expert Centers

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND: The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands.METHODS: Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.RESULTS: 130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90-180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %-92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %-60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.CONCLUSION: In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.

AB - BACKGROUND: The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett's esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed in the Netherlands.METHODS: Retrospective assessment of outcomes, using treatment and follow-up data from a joint database.RESULTS: 130/138 patients had complete ESDs, with 126/130 (97 %) en bloc resections. Median (interquartile range (IQR)) procedure time was 121 minutes (90-180). Pathology findings were high grade dysplasia (HGD) (5 %) or esophageal adenocarcinoma (EAC) T1a (43 %) or T1b (52 %; 19 % sm1, 33 % ≥ sm2). Among resections of HGD or T1a EAC lesions, 87 % (95 %CI 75 %-92 %) were both en bloc and R0; the corresponding value for T1b EAC lesions was 49 % (36 %-60 %). Among R1 resections, 10/34 (29 %) showed residual cancer, all detected at first endoscopic follow-up. The remaining 24 patients (71 %) showed no residual neoplasia. Six of these patients underwent surgery with no residual tumor; the remaining 18 underwent endoscopic follow-up during median 31 months with 1 local recurrence (annual recurrence rate 2 %). Among R0 resections, annual local recurrence rate during median 27 months was 0.5 %.CONCLUSION: In expert hands, ESD allows safe removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter showed R1 resection margins in 50 %, yet only one third had persisting neoplasia at follow-up. To better stratify R1 patients with an indication for additional surgery, repeat endoscopy after healing of the ESD might be a helpful possible prognostic factor for residual cancer.

KW - BENCHMARK QUALITY CRITERIA

KW - LYMPH-NODE METASTASIS

KW - EARLY ADENOCARCINOMA

KW - ESOPHAGUS

KW - RESECTION

KW - RISK

KW - MANAGEMENT

KW - DYSPLASIA

KW - INVASION

U2 - 10.1055/a-1658-7554

DO - 10.1055/a-1658-7554

M3 - Article

C2 - 34592769

SN - 0013-726X

VL - 54

SP - 531

EP - 541

JO - Endoscopy

JF - Endoscopy

IS - 06

ER -

Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

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Keywords

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