Endoscopic Submucosal Dissection is Associated with Less Pathologic Uncertainty than Endoscopic Mucosal Resection in Diagnosing and Staging Barrett's- Related Neoplasia. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Podboy, A., Kolahi, K. S., Friedland, S., Louie, C. Y. 2019


BACKGROUND & AIMS: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have demonstrated similar efficacy in removal of neoplastic esophageal lesions. However, significant controversy exists over the preferred resection technique. Our primary aim was to compare the pathologic specimens produced via EMR and ESD and secondarily gauge their effect on clinical decision making and patient outcomes.METHODS: Using a retrospective cohort study design, all esophageal Barrett's-associated neoplastic lesions resected by a single provider (SF) from 2012-2017 were reviewed. The pathology was re-reviewed by 2 blinded authors for diagnosis, margins, and. Adverse outcomes and recurrence rates were also collected.RESULTS: 31 EMR and 20 ESD cases were identified. Baseline demographics and lesion characteristics were similar. ESD produced more R0 resections and more en bloc resections compared to EMR. EMR produced more equivocal lateral (13/31, 41.9% vs 1/20, 5.0%) and vertical margins (13/31,41.9% vs. 0/20, 0%, both p<0.05). This led to an inability to reach a definitive diagnosis in 13/31 EMR vs 0/20 ESD pathology specimens (p=.003). Of the 13 EMR specimens with equivocal pathology, 11 were noted to have 'at least intramucosal adenocarcinoma'. 4/11 patients chose to undergo elective esophagectomy with final surgical pathology demonstrating =T1a disease in 2, and =T1b disease in 2.CONCLUSION: Compared to ESD, EMR was associated with greater pathologic uncertainty in Barrett's-associated neoplasia This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/den.13487

View details for PubMedID 31306525