Thomas Jefferson University Hospital Philadelphia, PA, United States
Divya M. Chalikonda, MD1, Jason Ho, MD2, Adina Kazan, BA2, Christina Tofani, MD2, Alex Schlachterman, MD2, Anthony Infantolino, MD2 1Thomas Jefferson University Hospital, Bethlehem, PA; 2Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Barrett’s esophagus (BE) is a known precursor to esophageal dysplasia and adenocarcinoma. First line therapy for BE with dysplasia includes endoscopic mucosal resection (EMR) for raised lesions followed by radiofrequency ablation (RFA) for remaining flat dysplastic tissue. Recently, advancements in the field of endoscopic submucosal dissection (ESD) have expanded this technique to en-bloc resection of dysplastic and early cancerous tissue in the esophagus. Safety and feasibility of ESD have been studied, however, clear indications for this procedure are lacking. We aim to characterize indications for ESD and its outcomes in patients with high-grade BE at our institution.
Methods: This was an observational, retrospective cohort study evaluating patients at a tertiary care center who underwent ESD for BE with dysplasia or T1 lesions. We queried the Endoscopy Procedure Documentation system for all ESDs performed at our institution in the esophagus. All patients who underwent ESD for esophageal adenocarcinoma were included; patients with esophageal squamous cell carcinoma were excluded. Chart reviews were conducted to obtain patient demographics at the time of ESD, pathology, including lymphovascular invasion prior to ESD, nodularity at the time of ESD, as well as outcomes and complications after the procedure.
Results: 15 patients underwent ESD for high-grade BE. Demographics, pathology and indication for ESD are detailed in Table 1,2 and 3. 14/15 patients had nodules present and 2/14 had more than 1 nodule. 5/15 had EMR performed prior to ESD; 4/5 had positive margins from the EMR. The most common pathology prior to ESD was T1a (9/15). The most common indication for ESD was nodule size. All procedures were performed successfully, with stricture and bleeding documented as complications. 4/15 patients had positive margins on dissected specimen and surgery was recommended after ESD for 2/15.
Discussion: ESD is a promising technique that has had an increasing role in management of high-grade BE. However, variability in this disease presentation has limited a standardized approach to incorporation of ESD. Our institution’s experience with ESD for high-grade BE indicates that numerous factors exist in consideration of ESD beyond those listed by current best practice guidelines. Gastroenterologists would benefit from a standardized approach to considering ESD in management of high-grade BE.
Figure: Demographics and Clinical Characteristics of Patients who Underwent ESD for High-Grade BE
Divya Chalikonda indicated no relevant financial relationships.
Jason Ho indicated no relevant financial relationships.
Adina Kazan indicated no relevant financial relationships.
Christina Tofani indicated no relevant financial relationships.
Alex Schlachterman: Conmed – Consultant. Lumendi – Consultant.
Anthony Infantolino indicated no relevant financial relationships.
Divya M. Chalikonda, MD1, Jason Ho, MD2, Adina Kazan, BA2, Christina Tofani, MD2, Alex Schlachterman, MD2, Anthony Infantolino, MD2. P2399 - Indications and Outcomes With Endoscopic Submucosal Dissection for High-Grade Barrett’s Esophagus, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.