Endotherapy for superficial adenocarcinoma of the esophagus: an American experience

BackgroundEMR and ablation are increasingly being used alone or in combination for treatment of Barrett's neoplasia. Given a very low rate of lymph node metastasis, endotherapy has become an accepted treatment option for T1a esophageal adenocarcinoma (EAC) with low-risk features.ObjectiveTo report our experience of endoscopic management of T1a EAC in a large, tertiary-care center.DesignRetrospective review.SettingTertiary-care referral center.PatientsPatients treated endoscopically for low-risk T1a EAC at our center.InterventionEMR and endoscopic ablation.Main Outcome MeasurementsDeath related to esophageal cancer, remission of adenocarcinoma, dysplasia, and intestinal metaplasia.ResultsA total of 54 patients underwent endotherapy for low-risk T1a EAC from 2006 to 2012. Mean (± SD) follow-up was 23 (± 16) months, mean (± SD) size of resected adenocarcinoma was 7.1 (± 4.3) mm, and mean (± SD) Barrett's esophagus length was 4.5 (± 3.9) cm. Band-assisted, cap-assisted, and lift and cut EMR were performed in 85%, 11%, and 4% of patients, respectively; 81% underwent additional ablative therapy (radiofrequency ablation 95%, cryotherapy 9%, photodynamic therapy 2%). Complete remission from cancer was achieved in 96%, complete remission from dysplasia in 87%, and complete remission from intestinal metaplasia in 59%. The overall survival was 89%; there were no deaths related to esophageal cancer.LimitationsRetrospective study.ConclusionEndotherapy for T1a EAC was safe and effective in our American cohort. Endotherapy should be considered primary therapy for appropriate patients with low-risk lesions. Complete Barrett's esophagus eradication after EMR is important to reduce the development of metachronous lesions.