Brief Reports
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2005; 11(42): 6650-6655
Published online Nov 14, 2005. doi: 10.3748/wjg.v11.i42.6650
Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett’s esophagus: An Italian experience
Massimo Conio, Alessandro Repici, Renzo Cestari, Sabrina Blanchi, Gabriella Lapertosa, Guido Missale, Domenico Della Casa, Vincenzo Villanacci, Pier Gigi Calandri, Rosangela Filiberti
Massimo Conio, Department of Gastroenterology, Sanremo, Italy
Alessandro Repici, Department of Gastroenterology, Molinette Hospital, Torino, Italy
Renzo Cestari, Guido Missale, Domenico Della Casa, Department of Surgical-Surgery Endoscopy, Spedali Civili, University of Brescia, Italy
Sabrina Blanchi, Department of Internal Medicine, University of Genova, Italy
Gabriella Lapertosa, Division of Pathology, University of Genova, Italy
Vincenzo Villanacci, 2nd Department of Pathology, Spedali Civili, University of Brescia, Italy
Pier Gigi Calandri, Anesthesia and Resuscitation Unit, National Institute for Cancer Research, Genova, Italy
Rosangela Filiberti, Epidemiology and Biostatistics, National Institute for Cancer Research, Genova, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Massimo Conio, MD, Department of Gastroenterology, Sanremo Hospital, 18038 Sanremo (IM), Italy.
Telephone: +39-0184-536873 Fax: +39-0184-536873
Received: December 11, 2004
Revised: February 15, 2005
Accepted: February 18, 2005
Published online: November 14, 2005

AIM: To evaluate endoscopic mucosal resection (EMR) in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett’s esophagus (BE).

METHODS: Between June 2000 and December 2003, 39 consecutive patients with HGD (35) and/or IMC (4) underwent EMR. BE >30 mm was present in 27 patients. In three patients with short segment BE (25.0%), HGD was detected in a normal appearing BE. Lesions had a mean diameter of 14.8±10.3 mm. Mucosal resection was carried out using the cap method.

RESULTS: The average size of resections was 19.7±9.4×14.6±8.2 mm. Histopathologic assessment post-resection revealed 5 low-grade dysplasia (LGD) (12.8%), 27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%). EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwent surgery. Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy, occurred in four patients (10.3%). After a median follow-up of 34.9 mo, all patients remained in remission.

CONCLUSION: In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.

Keywords: Endoscopic mucosal resection, Barrett’s esophagus, High-grade dysplasia, Intramucosal cancer