Impact of endoscopic mucosal resection in patients referred for endoscopic management of Barrett's esophagus

BackgroundBarrett's esophagus (BE) may be managed by radiofrequency ablation, endoscopic mucosal resection (EMR), and surgical resection for advanced lesions. The goal of this study was to evaluate the impact of EMR in patients referred for management of BE.MethodsAll patients referred to a tertiary center for management of BE between January 1, 2009 and August 7, 2012 were reviewed and stratified according to dysplasia, Barrett's-related neoplasm, and nodularity. Endpoints included histopathologic characterization of esophageal tissue biopsies and EMR specimens, discrepancy between diagnoses, and subsequent change in management following EMR.ResultsIn total, 2648 endoscopies were reviewed. Thirty-five patients having a total of 38 EMRs were included. Mucosal tissue biopsy and EMR specimens were discordant in 24 of 38 specimens (63%). Of these, 20 biopsy results were upstaged (53%) and four downstaged (10.5%) following EMR. The most common change was upstaging to invasive adenocarcinoma. EMR diagnosed 13 cases of invasive carcinoma, 12 of which were upstaged (92%). Based on EMR results, management was changed in 13 cases (34%), primarily to surgery.ConclusionMucosal biopsies and EMR results were discrepant in 63% of cases, with 53% resulting in an upstaged diagnosis. Approximately one-third of these patients had a change in management. In patients referred for BE, EMR was found to be fundamental to accurate grading and should be a component in the evaluation and management of Barrett-related lesions.