Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation (2024)

Endoscopy, Table of Contents

Endoscopy
DOI: 10.1055/a-2307-6949

Original article

Lauriane Mesureur

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

Pierre H. Deprez

²Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

Raf Bisschops

³Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Leuven, Leuven, Belgium

¹³Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

Masami Omae

¹³Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

Mathieu Pioche

¹⁴Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

Mariana Figueiredo Ferreira

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

Michael J. Bourke

¹⁵Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

Rehan Haidry

¹⁶Department of Gastroenterology, University College London Hospital (UCLH), London, United Kingdom of Great Britain and Northern Ireland

Christophe Snauwaert

¹⁷Department of Hepatology and Gastroenterology, Sint-Jan Hospital, Bruges, Belgium

Pierre Eisendrath

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

Viviane De Maertelaer

¹⁸Institute of Interdisciplinary Research (IRIBHM), Statistical Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium

Nicolas Rosewick

¹⁹Laboratory of Experimental Gastroenterology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libre de Bruxelles (ULB), Brussels, Belgium

Jacques Devière

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

Arnaud Lemmers

¹Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), Université Libres de Bruxelles (ULB), Brussels, Belgium

› Author Affiliations

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Abstract

Background This study evaluated the safety and efficacy of salvage endoscopic submucosal dissection (ESD) for Barrett’s neoplasia recurrence after radiofrequency ablation (RFA).

Methods Data from patients at 16 centers were collected for a multicenter retrospective study. Patients who underwent at least one RFA treatment for Barrett’s esophagus and thereafter underwent further esophageal ESD for neoplasia recurrence were included.

Results Data from 56 patients who underwent salvage ESD between April 2014 and November 2022 were collected. Immediate complications included one muscular tear (1.8%) treated with stent (Agree classification: grade IIIa). Two transmural perforations (3.6%; treated with clips) and five muscular tears (8.9%; two treated with clips) had no clinical impact and were not considered as adverse events. Seven patients (12.5%) developed strictures (grade IIIa), which were treated with balloon dilation. Histological analysis showed 36 adenocarcinoma, 17 high grade dysplasia, and 3 low grade dysplasia. En bloc and R0 resection rates were 89.3% and 66.1%, respectively. Resections were curative in 33 patients (58.9%), and noncurative in 22 patients (39.3%), including 11 “local risk” (19.6%) and 11 “high risk” (19.6%) resections. At the end of follow-up with a median time of 14 (0–75) months after salvage ESD, and with further endoscopic treatment if necessary (RFA, argon plasma coagulation, endoscopic mucosal resection, ESD), neoplasia remission ratio was 37/53 (69.8%) and the median remission time was 13 (1–75) months.

Conclusion In expert hands, salvage ESD was a safe and effective treatment for recurrence of Barrett’s neoplasia after RFA treatment.

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References

References
1 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198 DOI: 10.1055/s-0042-122140. (PMID: 28122386)
2 Pech O, May A, Manner H. et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660
3 Phoa KN, Pouw RE, Bisschops R. et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2016; 65: 555-562 DOI: 10.1136/gutjnl-2015-309298. (PMID: 25731874)
4 Phoa KN, van Vilsteren FGI, Weusten BLAM. et al. Radiofrequency ablation vs endoscopic surveillance for patients with barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014; 311: 1209
5 Shaheen NJ, Sampliner RE, Goldblum JR. et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
6 Kahn A, Al-Qaisi M, Kommineni VT. et al. Longitudinal outcomes of radiofrequency ablation versus surveillance endoscopy for Barrett’s esophagus with low-grade dysplasia. Dis Esophagus 2018; 31: 4
7 Small AJ, Araujo JL, Leggett CL. et al. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett’s esophagus and confirmed low-grade dysplasia. Gastroenterology 2015; 149: 567-576
8 Haidry RJ, Dunn JM, Butt MA. et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic Barrett’s esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology 2013; 145: 87-95 DOI: 10.1053/j.gastro.2013.03.045. (PMID: 23542069)
9 van Munster S, Nieuwenhuis E, Weusten BLAM. et al. Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: results from the national Dutch database in a 10-year period. Gut 2022; 71: 265-276
10 Wolfson P, Ho KMA, Wilson A. et al. Endoscopic eradication therapy for Barrett’s esophagus-related neoplasia: a final 10-year report from the UK National HALO Radiofrequency Ablation Registry. Gastrointest Endosc 2022; 96: 223-233
11 van Munster SN, Nieuwenhuis E, Bisschops R. et al. Dysplastic recurrence after successful treatment for early Barrett’s neoplasia: development and validation of a prediction model. Gastroenterology 2022; 163: 285-294 DOI: 10.1053/j.gastro.2022.03.020. (PMID: 35306024)
12 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2022. Endoscopy 2022; 54: 591-622 DOI: 10.1055/a-1811-7025. (PMID: 35523224)
13 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085 DOI: 10.1016/j.gie.2021.11.038. (PMID: 34890695)
14 van Munster SN, Verheij EPD, Nieuwenhuis EA. et al. Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures. Endoscopy 2022; 54: 531-541 DOI: 10.1055/a-1658-7554. (PMID: 34592769)
15 Pimentel-Nunes P, Pioche M, Albéniz E. et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51: 980-992 DOI: 10.1055/a-0996-0912. (PMID: 31470448)
16 Subramaniam S, Chedgy F, Longcroft-Wheaton G. et al. Complex early Barrett’s neoplasia at 3 Western centers: European Barrett’s Endoscopic Submucosal Dissection Trial (E-BEST). Gastrointest Endosc 2017; 86: 608-618 DOI: 10.1016/j.gie.2017.01.027. (PMID: 28159540)
17 Yang D, Coman RM, Kahaleh M. et al. Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc 2017; 86: 600-607 DOI: 10.1016/j.gie.2016.09.023. (PMID: 27688205)
18 Omae M, Hagström H, Ndegwa N. et al. Wide-field endoscopic submucosal dissection for the treatment of Barrett’s esophagus neoplasia. Endosc Int Open 2021; 09: E727-734 DOI: 10.1055/a-1386-3668. (PMID: 33937514)
19 Tomizawa Y, Friedland S, Hwang JH. Endoscopic submucosal dissection (ESD) for Barrett’s esophagus (BE)-related early neoplasia after standard endoscopic management is feasible and safe. Endosc Int Open 2020; 8: E498-505 DOI: 10.1055/a-0905-2465. (PMID: 32258371)
20 Chevaux JB, Piessevaux H, Jouret-Mourin A. et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia. Endoscopy 2015; 47: 103-12
21 Bucalau AM, Lemmers A, Sidhu N. et al. Endoscopic submucosal dissection for Barrett’s esophagus large or fibrotic visible lesions: a bicentric Western country prospectively collected experience. Endoscopy 2019; 51: 4
22 Englebert G, Carpentier D, Bucalau AM. et al. Local injection of triamcinolone acetonide with selected added oral steroid therapy after extensive esophageal ESD to prevent stricture: a prospective validation protocol in Western countries. Endoscopy 2022; 54: S24
23 Probst A, Aust D, Märkl B. et al. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2014; 47: 113-121 DOI: 10.1055/s-0034-1391086. (PMID: 25479563)
24 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 2017; 66: 783-793 DOI: 10.1136/gutjnl-2015-310126. (PMID: 26801885)
25 Kagemoto K, Oka S, Tanaka S. et al. Clinical outcomes of endoscopic submucosal dissection for superficial Barrett’s adenocarcinoma. Gastrointest Endosc 2014; 80: 239-245 DOI: 10.1016/j.gie.2014.01.022. (PMID: 24565073)
26 Barret M, Cao DT, Beuvon F. et al. Endoscopic submucosal dissection for early Barrett’s neoplasia. United European Gastroenterol J 2016; 4: 207-215 DOI: 10.1177/2050640615608748. (PMID: 27087948)
27 Coman RM, Gotoda T, Forsmark CE. et al. Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrett’s esophagus: a Western center experience. Endosc Int Open 2016; 4: E715-721
28 Pioche M, O’Brien M, Rivory J. Please provide us with a reasonable definition for curative R0 resection in Barrett’s esophagus neoplasia; which one should we choose?. Endosc Int Open 2015; 3: E566-568 DOI: 10.1055/s-0034-1392648. (PMID: 26716113)

Supplementary Material

Supplementary Material

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