Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 763-769
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.763
Outcomes of submucosal (T1b) esophageal adenocarcinomas removed by endoscopic mucosal resection
Darren D Ballard, Neel Choksi, Jingmei Lin, Eun-Young Choi, B Joseph Elmunzer, Henry Appelman, Douglas K Rex, Hala Fatima, William Kessler, John M DeWitt
Darren D Ballard, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Neel Choksi, Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, United States
Jingmei Lin, Department of Pathology, Indiana University, Indianapolis, IN 46202, United States
Eun-Young Choi, Henry Appelman, Department of Pathology, University of Michigan, Ann Arbor, MI 48109, United States
B Joseph Elmunzer, Division of Gastroenterology and Hepatology, University of South Carolina, Charleston, SC 29425, United States
Douglas K Rex, Hala Fatima, William Kessler, John M DeWitt, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN 46202, United States
Author contributions: Ballard DD and DeWitt JM designed the research; Ballard DD, Choksi N, Lin J, Choi EY, Elmunzer BJ, Appelman H, Rex DK, Fatima H, Kessler W and DeWitt JM performed the research; Ballard DD and DeWitt JM analyzed the data; Ballard DD and DeWitt JM wrote the manuscript; Choksi N, Lin J, Choi EY, Elmunzer BJ, Appelman H, Rex DK, Fatima H and Kessler W critically reviewed the manuscript.
Institutional review board statement: The study was reviewed and approved by the IRB at Indiana University and the University of Michigan.
Informed consent statement: No informed consent was required as this was a retrospective study approved by the IRB.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors of this study.
Data sharing statement: Dataset is available from the corresponding author at dballard@mcw.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Darren D Ballard, Assistant Professor, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, United States. dballard@mcw.edu
Telephone: +1-414-9556821 Fax: +1-414-9556215
Received: May 20, 2016
Peer-review started: May 20, 2016
First decision: July 20, 2016
Revised: August 23, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: December 16, 2016
AIM
To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments.
METHODS
Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC.
RESULTS
Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified.
CONCLUSION
Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.
Core tip: Endoscopic eradication therapy (EET) is reported as safe and effective for low risk T1b esophageal adenocarcinomas (EAC), but overall data is lacking. We retrospectively evaluated patients with T1b EAC treated with EET, EET with chemotherapy and/or radiation therapy and surgical resection. The overall recurrence rate was 28% at median 21 mo (range: 6-73) following EMR. In those treated with endoscopic mucosal resection alone, recurrence rate was 38% at median 21 mo (range: 6-73). Six of the 9 recurrences were local; 5 were treated with endoscopy alone. EET of T1b EAC may be a reasonable treatment strategy for a subset of these patients.
