Sa1530 Complete Barrett's Eradication Endoscopic Mucosal Resection (CBE-EMR) for High-Grade Dysplasia (HGD) and Intramucosal Carcinoma (IMC): Intermediate Term Results At 3.5 Years of Follow Up

The rationale for complete Barrett's eradication endoscopic resection (CBE-EMR) is based on the high rate of synchronous/metachronous neoplasia arising in the residual Barrett's epithelium when focal EMR is only used to treat specific lesions. Aim: We report the complete remission rates of high grade dysplasia and intramucosal carcinoma (CR-HGD/IMC), all dysplasia (CR-D) and intestinal metaplasia (CR-IM) in patients who underwent a CBE-EMR protocol for the treatment of BE with HGD or IMC. All BE patients with HGD/IMC who underwent CBE-EMR (Jan'2003-Nov'10) were retrospectively reviewed from a prospectively collected database of all patients enrolled in our institution's BE neoplasia treatment protocol. At the end of the CBE-EMR protocol patients underwent EGD with mapping biopsies of the originally involved levels. Patients then entered surveillance defined as starting with the first EGD performed 1 year after the last treatment session. Rescue EMR, defined as the additional removal of any endoscopic suspicious areas, was performed as needed after treatment protocol. A total of 73 patients (mean age 66.3 years, 75% men) with BE (median length 3 cm, long segment=36, short segment=37) and proven HGD (N=47) or IMC (N=26) underwent CBE-EMR. Final staging after EMR was non-BE 1 (1.4%), non dysplastic BE (NDBE) 4 (5.5%), low grade dysplasia (LGD) 6 (8.2%), HGD 38 (52%), IMC 19 (26%) and submucosal invasion in 5 (6.9%). Of all enrolled patients, 6 were referred to surgery due to the final EMR staging, 9 dropped out or were lost from protocol, 18 are undergoing treatment (6 for initial circumferential therapy and 12 being assessed and treated for any residual areas) and 40 entered in surveillance. In the surveillance cohort, 90 EMR sessions were performed (mean per patient 2.2, median 2) and 423 EMR samples were obtained (mean per session 4.7, median 7). Rescue EMR was performed in 3 patients with endoscopic suspicious areas during the surveillance period which revealed normal squamous epithelium in 2 cases and NDBE in one. After a follow-up period of 47 months (mean 46) from last CBE-EMR procedure, CR-HGD/IMC was achieved in 100%, CR-D in 95% (38/40) and CR-IM in 82.5% (33/40). No recurrences of HGD/IMC were seen. 5 patients had persistent BE (2 buried glands, 1 LGD) and recurrence of IM was noted in 2 patients (1 LGD). Symptomatic stenoses during surveillance were noted in 8 patients (20%). Total of 11 dilation sessions were performed (mean 1.4) to relieve symptoms. CBE-EMR is an effective BE neoplasia treatment option to reduce the risk of metachronous lesion development. After an intermediate-term 3.5-year follow up period, all patients are in complete remission of HGD and IMC. No recurrences of HGD or IMC occurred during surveillance. Symptomatic stenoses can be resolved by endoscopic treatment.