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ENDOSCOPIC MUCOSAL RESECTION (EMR) OF THE ESOPHAGUS: EARLY RESULTS
M Brahmania, E Lam, J Telford, R Enns
St Paul’s Hospital, Vancouver, British Columbia
Aims: Endoscopic mucosal resection (EMR) of the esophagus has been proposed as an ideal method to manage patients with either dysplasia or mucosal based cancers. For the past 3 years, all patients referred with esophageal lesions have been considered for EMR. We report our experience with this technique to assess efficacy, complication rate and long term outcomes.
Methods: All patients were referred from throughout British Columbia were considered for EMR. All patients were staged with aggressive biopsy protocols using a ‘jumbo’ biopsy forcept to assess underlying pathology. Those with detected cancers were staged with both endoscopic ultrasound and computerized tomography. Appropriate patients were offered EMR using the Cook Endoscopy Duette® Multiband Mucosectomy Device. No limit to the number of resections per session were used, however, circumferential resections were avoided. Endoscopic resections were repeated in 6-8 week intervals.
Results: 18 patients (all male, mean age 67 yrs range 44-82) have adequate follow up to be included. All were on PPI therapy with a mean of 15 yrs of GERD. The mean length of Barrett’s esophagus was 5.4 cm: 1 had no dysplasia, 1 LGD, 13 high grade dysplasia and 3 adenocarcinoma- all of the distal esophagus. A mean of 1.9 (SD 0.85) endoscopic sessions with a mean of 6.7 (range 1-26) sections removed total. Two patients with pre-existing strictures were subsequently sent for surgery and one other patient required dilation following the EMR. No perforations or episodes of GI bleeding occurred as a complication. At a mean follow up of two years, no patient has died or developed recurrence/metastatic disease.
Conclusions: Even with our limited experience in this area, most patients with localized lesions of the esophagus can be managed endoscopically with a low complication and surgical conversion rate. Those with pre-existing strictures require other endoscopic methods to access their altered anatomy for resection.