Intraepithelial High-Grade Neoplasia and Early Adenocarcinoma in Short-Segment Barrett’s Esophagus (SSBE): Curative Treatment Using Local Endoscopic Treatment Techniques

 

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Background and Study Aims: In recent years, short-segment Barrett’s esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation.
Patients and Methods: Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett’s adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments.
Results: Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 ± 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 ± 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett’s adenocarcinoma (this was the patient who underwent esophageal resection).
Conclusions: The malignant potential of short-segment Barrett’s esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett’s esophagus.

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C. Ell, M.D., Ph.D.

Department of Internal Medicine II · HSK Wiesbaden

Ludwig-Erhard-Straße 100 · 65199 Wiesbaden · Germany

Fax: + 49-611-432418

Email: Med2.hsk-wiesbaden@knuut.de