Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Therap Adv Gastroenterol. 2009 Nov;2(6):323-30. doi: 10.1177/1756283X09346794.

Endoscopic Resection with Ligation Using a Multi-Band Mucosectomy System in Barrett's Esophagus with High-Grade Dysplasia and Intramucosal Carcinoma.

Author information

  • 1Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA ybhat@mednet.ucla.edu.

Abstract

BACKGROUND:

Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving. Endoscopic resection has an increasing role. We wanted to evaluate the safety and efficacy of multi-band ligation/resection [ER-L] without pre-injection in BE with high-grade dysplasia [HGD] and intramucosal carcinoma [IMCA].

METHODS:

A cohort of 65 consecutive patients from a single academic medical center, who underwent ER-L as part of endoscopic eradication therapy for BE with HGD/IMCA were studied. ER-L was performed afterendoscopic mapping and endoscopic ultrasound (EUS). Subsequently, adjunctive ablative therapies including photodynamic therapy, argon plasma coagulation and radiofrequency ablation were applied to achieve complete eradication of all BE. Thereafter biopsy surveillance was performed per protocol. All patients were prescribed a proton-pump inhibitor.

MAIN OUTCOME MEASUREMENTS:

Change in histopathological stage; eradication of BE and HGD/IMCA; adverse events.

RESULTS:

The median number of ER-L applications in each session was 4 (range 1-6) and the mean total number of ER-L sessions was 1.5. Compared with prior forceps biopsy, histopathology from the ER-L specimen changed in 24 (37.5%, p = <0.0001). With median follow-up of 15 months (range 8-42), complete and durable BE eradication was achieved with ER-L alone in 36 (60%) and the remainder with adjunctive ablation therapies. There were nine complications (four (6%) acute bleeding, five (7.5%) strictures, zero perforations).

CONCLUSIONS:

ER-L without submucosal (SM) pre-injection is safe and effective when applied selectively for eradication of BE with HGD/IMCA. There is significant change in pathological stage after ER-L conferring a diagnostic and staging advantage. ER-L may be used adjunctively with ablation therapies.

KEYWORDS:

Barrett's esophagus; early esophageal cancer; endoscopic treatment of Barrett's esophagus

PMID:
21180580
[PubMed]
PMCID:
PMC3002559
Free PMC Article

Images from this publication.See all images (3)Free text

Figure 1.
Figure 2.
Figure 3.
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for PubMed Central
    Loading ...
    Write to the Help Desk