Endoscopic resection techniques and ablative therapies for Barrett’s neoplasia

Table 1 Focal endoscopic mucosal resection in early Barrett’s neoplasia

Author	n	Complete regression of dysplasia/esophageal cancer (%)	Histology	Follow-up (mo)
Ell et al[43], 2000	64	86	HGD/EC	12 ± 8
May et al[44], 2002	28	79 (1001)	HGD/EC	34 ± 10
May et al[45], 2002	70	70 (981)	HGD/EC	34 ± 10
Behrens et al[48], 2005	14	93 (1001)	HGD	38
Peters et al[49], 2005	33	79 (1001)	Barrett’s esophagus	19
Conio et al[50], 2005	39	97.5	HGD/EC	35
Ell et al[53], 2007	100	88 (991)	Adenoca.	36
Pech et al[41], 2008	231	95.7	EC	61
Moss et al[54], 2010	35	77 (851)	HGD/EC	31

¹Results after second treatment. EC: Esophageal cancer; HGD: High grade dysplasia.

Table 2 Changes in final histopathological diagnosis after endoscopic mucosal resection

Author	n	Discrepant diagnosis (%)	Upstaging (%)	Downstaging (%)
Hull et al[59], 20061	41	39	34	5
Chennat et al[60], 2009	49	44.8	14	31
Moss et al[54], 2010	75	48	20	28

¹Includes esophageal and gastric neoplasms.

Table 3 Complete Barrett’s eradication-endoscopic mucosal resection results

Author	n	Complete regression of intestinal metaplasia (%)	Complete regression of dysplasia/esophageal cancer (%)	Sessions (%)	Recurrence (%)	Progression (%)	Follow-up (mo)
Seewald et al[65], 2003	12	100	100	2.5	0	0	9
Giovannini et al[66], 2004	21	75	86	2	14	0	18
Peters et al[67], 2006	39	89	95	3	0	0	11
Larghi et al[68], 2007	24	87	100	1.8	4	0	28
Lopes et al[69], 2007	41	76	90	1.5	12	0	31.6
Chennat et al[60], 2009	49	97	100	2.1	0	0	17
Moss et al[54], 2010	35	97	97	2	0	0	31
Pouw et al[63], 2010	169	97.6	85.2	2	1.8	0.6	27

Table 4 Complete Barrett’s eradication-endoscopic mucosal resection complications

Author	n	Perforation (%)	Bleeding1 (%)	Stricture (%)
Seewald et al[65], 2003	12	0	0	16.6
Giovannini et al[66], 2004	21	0	0	0
Peters et al[67], 2006	39	2.56	2.56	26
Larghi et al[68], 2007	24	0	0	12.5
Lopes et al[69], 2007	41	9.5	0	4.76
Chennat et al[60], 2009	49	0	0	36.7
Moss et al[54], 2010	35	0	0	14.3
Pouw et al[63], 2010	169	2.4	2.4	50

¹Only bleeding cases in which endoscopic treatment was needed.

Table 5 Endoscopic submucosal dissection in esophageal cancer

Author	n	En bloc resection rate (%)	Curative resection rate (resection margins free of neoplasia) (%)	Recurrence (%)	Histology	Follow-up (mo)
Oyama et al[75], 2005	102	95	95	-	Squamous	-
Fujishiro et al[76], 2006	43	100	-	2.3	Squamous	17
Kakushima et al[77], 2006	30	97	70	01	Adenoca. 2	15
Motohashi et al[78], 2009	9	100	100	0	N/D	12
Ono et al[79], 2009	84	100	88	3.6	N/D	21
Ishii et al[80], 2010	35	100	95	01	Adenoca./Squamous.	19
Neuhaus et al[81], 2010	18	83	22	5.5	BE (HGIN/IMC)	1.5
Yoshinaga et al[82], 2008	24	100	72	01	Adenoca.2	30

¹R0 margin lesions (free of disease margins);

²Esophagogastric junction lesions; N/D: No data; BE: Barrett's esophagus; HGIN: High-grade intraepithelial neoplasia; IMC: Intramucosal carcinoma.

Table 6 Endoscopic mucosal resection vs endoscopic submucosal dissection in esophageal cancer

Author	n		En bloc resection rate (%)		Curative resection rate (resection margins free of disease) (%)		Complications1 (%)
	EMR	ESD	EMR	ESD	EMR	ESD	EMR	ESD
Ishihara et al[84], 2008	148	29	78.5	100	57.8	97	0.03	0.03
Jung et al[85], 2008	69	37	25	97.3	53.1	86.5	12.5	16
Teoh et al[86], 2008	26	11	71.4	94.4	-	-	0.06	0.36
Deprez et al[87], 2010	25	25	0	96	24	64	52	24

¹Perforations + bleeding + stricture demanding dilatation. All of them were successfully treated by endoscopic approach. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 7 Radiofrequency ablation non-randomized prospective trials

Author	n	Complete regression of intestinal metaplasia (%)	Complete regression of dysplasia/early cancer (%)	Patients	Study	Follow-up (mo)
Roorda et al[97], 2007	13	46	71	BE	Single-center	12
Sharma et al[98], 2007	70	70	-	Non D-BE	Multic.	12
Fleischer et al[99], 20081	70	70-98	-	Non D-BE	Multic.	12-30
Ganz et al[100], 2008	142	54.3	80.4-90.2	HGD	Multic.	12
Pouw et al[101], 2008	44	98	-	BE	Single-center	21
Gondrie et al[102], 2008	11	100	100	BE	Single-center	14
Gondrie et al[103], 2008	12	100	100	BE	Single-center	14
Sharma et al[104], 2008	10	90	100	LGD	Single-center	24
Hernandez et al[105], 2008	10	70	-	BE	Single-center	12
Sharma et al[106], 2009	63	79	89	LGD/HGD	Single-center	24
Velanovich[107], 2009	66	93	-	BE	Single-center	12
Vassiliou et al[108], 2010	25	78.5	-	LGD/HGD/IMC	Single-center	20
Lyday et al[109], 2010	429	72	89	LGD/HGD	Multic.	9
Eldaif et al[110], 2010	27	100	-	Non D-BE/LGD	Single-center	2
Fleischer et al[111], 20102	50	92	-	Non D-BE	Multic.	60

¹Outcomes at 2.5 years f/u;

²Outcomes at 5 years f/u. Non D-BE: Non dysplastic Barrett’s esophagus; BE: Dysplastic and non dysplastic Barrett’s esophagus; LGD: Low grade dysplasia; HGD: High grade dysplasia; IMC: Intramucosal carcinoma.

Table 8 Radiofrequency ablation randomized, prospective and sham-control trial[113]

Study characteristics	Radiofrequency ablation group	Sham group	P value
n = 127 Dysplastic Barrett’s esophagus patients	84	43	-
Complete regression of intestinal metaplasia	77.4%	2.3%	< 0.001
Complete regression of low grade dysplasia	90.5%	22.7%	< 0.001
Complete regression of high grade dysplasia	81.0%	19.0%	< 0.001
Global progression rate	3.6%	16.3%	< 0.05
Progression to cancer rate	1.2%	9.3%	< 0.05

Table 9 Stepwise treatment (endoscopic mucosal resection + radiofrequency ablation)

Results	End of treatment	Follow-up (22 mo)
Pouw et al[115], 2010
Complete regression of neoplasia	20/21 (95%)1	24/24 (100%)
Complete regression of intestinal metaplasia	21/24 (88%)2	20/24 (83%)
Progression	0%	0%
Buried glands (1201 biopsies)	0%	0%
Pouw et al[116], 2010
Complete regression of neoplasia	55/55 (100%)	N/A
Complete regression of intestinal metaplasia	53/55 (96%)	N/A
Progression	0%	N/A
Buried glands	N/D	N/A

¹100% after escape endoscopic mucosal resection (EMR);

²96% after escape EMR; N/D: No data.

Table 10 Photodinamic therapy in Barrett’s esophagus

Autor	n	Study	Sessions	Complete regression of intestinal metaplasia (%)	Complete regression of dysplasia/early cancer (%)	Recurrence (%)	Follow-up (mo)
Wolfsen et al[118], 2002	48	Case series	1	56	98	N/D	18.5
Ackroyd et al[119], 2003	40	Case series	1	0	100	2.5	53
Overholt et al[120], 2003	94	Case series	1-2	56	80	N/D	50
Wolfsen et al[121], 2004	102	Case series	1	56	N/D	N/D	19
Overhalt et al [122], 2005	138	Randomized controlled trial	2	52	59	1.4	24
Pech et al[123], 2005	66	Case series	1.2	N/D	98	17	37

Table 11 Cryotherapy in Barrett’s esophagus

Author	n	Complete regression of intestinal metaplasia (%)	Complete regression of dysplasia (%)	Complete regression of high grade dysplasia (%)	Patients	Follow-up (mo)
Johnston et al[127], 2005	9	78	-	-	Non D-BE/LGD/HGD	6
Canto et al[128], 2009	44	50	84	86	HGD/IMC	12
Greenwald et al[129], 2010	21	46	79	83	HGD/IMC	12
Shaheen et al[130], 2010	60	57	87	97	HGD	10.5

Non D-BE: Non dysplastic Barrett’s esophagus; LGD: Low grade dysplasia; HGD: High grade dysplasia; IMC: Intramucosal carcinoma.