Endoscopic mucosal resection provides good outcomes in patients with Barrett’s esophagus and early adenocarcinoma

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016


San Diego, CA, May 21, 2016—Patients with Barrett’s esophagus (BE) and early esophageal adenocarcinoma (EAC) who undergo endoscopic mucosal resection (EMR) have a low rate of EAC recurrence, according to data presented here at Digestive Disease Week 2016. In addition, researchers found that patients with short segment BE may also be at risk for EAC, and that EMR specimens with EAC-positive margins may be successfully managed with repeat EMR.

Take-home messages

  • A standardized approach to following Barrett’s esophagus patients with T1a adenocarcinoma who have been treated with endoscopic mucosal resection is needed.
  • Barrett’s esophagus patients with T1a esophageal adenocarcinoma treated with endoscopic mucosal resection have a low recurrence rate.
  • Repeat endoscopic mucosal resection can be successfully used to manage specimens with esophageal adenocarcinoma-positive margins.

“We conducted our study because we know that esophageal adenocarcinoma is a known complication of BE, and part of the known progression of the disease. However, there is not a lot of data looking at what good follow-up standards are for patients who have undergone treatment for their early adenocarcinoma with EMR. Even the most recent guidelines that have come out have not really suggested a standardized approach to following up these patients,” explained lead author Christine Tofani, MD, gastroenterology fellow, Thomas Jefferson University Hospital, Pennsauken, NJ.

EA and its risks are dependent on whether the esophagus is dysplastic, noted Dr. Tofani. “Nondysplastic Barrett’s carries a relatively low risk of developing EA, about 0.1% per year risk; whereas patients with high-grade dysplasia can have a much increased risk of about 7% per year,” she explained.

Dr. Tofani and colleagues at Thomas Jefferson University Hospital (both the Philadelphia, PA, and the Pensauken, NJ, units) conducted this retrospective review in 31 patients with BE and early EAC who underwent EMR (93.55% male; median age: 67±9.7 years) to better define the outcome of EMR for T1a EAC; to analyze the characteristics of BE patients who underwent EMR for EAC; and to assess EMR for positive margins of EAC in initial resection specimens. Median age at BE diagnosis was 63±10.5 years, and for EAC diagnosis, 63±10.3 years. Median follow up was 29.1±21.9 months (range: 2-87 months).

BE segments ranged from < 1 cm to 14 cm; 54.84% of patients had short segment BE. In all, 61.29% of patients had EAC diagnosed on their first EGD at this institution. Upon pathology, 25.81% of EMR specimens had margins positive for EAC, and 75% of these patients had repeat EMR, of which 5 were successful and 1 required esophagectomy for persistently positive margins.

In 83.86% of patients, PET/CT was performed after EMR, and in 15.38%, results were positive. After EMR, 6.45% (2 patients) had recurrence of EAC at 70 and 71 months. Two patients (6.45%) had recurrence of EAC at 70 and 71 months, and underwent successful repeat EMR.

Dr. Tofani explained that they also had an unexpected finding: “It was thought that patients with long-segment BE were at a greater risk for developing adenocarcinoma. We found that about 54% of patients had short-segment BE, which was a little surprising for us, and an interesting finding.”

For clinicians treating these patients, she stressed the following: “We need to better define a standardized approach to following BE patients with T1a adenocarcinoma. In those who undergo EMR, it is unclear what their follow-up should be and what is the best way to approach them. Do they need PET/CT scans to look for other areas of disease or active disease? How many PET/CT scans should they have? Do they need to see a medical oncologist if they have clear margins on their EMR specimen?”