OGC P15 Outcomes of Endoscopic Submucosal Dissection for Neoplasia in Barrett's Oesophagus at a Single Tertiary UK Centre

Abstract Background Endoscopic therapies for dysplasia or early cancer in Barrett's Oesophagus have become well established over recent years. Endoscopic Submucosal Dissection (ESD) offers the benefit of en bloc resection and accurate histological staging of lesions which is particularly advantageous in cancers and may eliminate the need for major surgery in selected patients. However, ESD is not widely available in the United Kingdom (UK) and it remains a high risk procedure in Western settings with complication rates of up to 12–27% reported in the literature. Here we report our outcomes at a single tertiary referral centre in the UK. Methods Retrospective review of prospectively maintained database. Results 244 consecutive ESD were carried out in patients with Barrett's neoplasia with visible lesions. The mean age was 69.8 years and 201 patients were male. Median Prague classification was C2M5. The median lesion size was 30mm (range 5–120mm). En bloc resection was achieved in 95.5% of cases. Bleeding, perforation and strictures occurred in 0.82%, 0.82% and 6.97% of cases respectively. These were all managed endoscopically. Histology showed low grade dysplasia in 12 cases, high grade dysplasia in 37 cases, and adenocarcinoma in 192 cases. In the cases of adenocarcinoma, 131 were intramucosal (stage pT1a) and 60 were submucosally invasive (pT1b). Of the submucosally invasive cancers, 36 were SM1 and 24 >SM1. R0 resection was achieved in 74% of cancer cases. Following ESD, 93 patients underwent ablation of residual Barrett's, 25 underwent further endoscopic resection, 21 entered endoscopic surveillance only and 25 patients underwent oesophagectomy. Of the patients who underwent oesophagectomy, 9 were for T1b >SM1 disease, 8 for poor prognostic factors (including poorly differentiated adenocarcinoma, lymphovascular invasion or signet ring cells), 4 for R1 resection at deep margin, 3 for patient choice and 2 for difficult recurrence. Conclusions Our data demonstrates that ESD can be effectively targeted for cancers in patients based on endoscopic assessment by experienced endoscopists with 78.7% of procedures being carried out for early cancers. ESD is safe and effective in the majority of patients and informed the need for surgery in the appropriate group of individuals.