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http://dx.doi.org/10.5230/jgc.2021.21.e39

Endoscopic Submucosal Dissection for Superficial Barrett's Neoplasia in Korea: a Single-Center Experience  

Joo, Dong Chan (Department of Internal Medicine, Pusan National University College of Medicine)
Kim, Gwang Ha (Department of Internal Medicine, Pusan National University College of Medicine)
Lee, Bong Eun (Department of Internal Medicine, Pusan National University College of Medicine)
Lee, Moon Won (Department of Internal Medicine, Pusan National University College of Medicine)
Baek, Dong Hoon (Department of Internal Medicine, Pusan National University College of Medicine)
Song, Geun Am (Department of Internal Medicine, Pusan National University College of Medicine)
Lee, Sojeong (Department of Pathology, Pusan National University College of Medicine)
Park, Do Youn (St. Maria Pathology Laboratory)
Publication Information
Journal of Gastric Cancer / v.21, no.4, 2021 , pp. 426-438 More about this Journal
Abstract
Purpose: While the incidence of Barrett's neoplasia has been increasing in Western countries, the disease remains rare in Asian countries. Therefore, very few studies have investigated the endoscopic treatment for Barrett's neoplasia in Korea. Endoscopic submucosal dissection (ESD) enables en bloc and complete resection of gastrointestinal neoplastic lesions. This study aimed to evaluate the therapeutic outcomes of ESD for Barrett's neoplasia in a single center in Korea and to examine the predictive factors for incomplete resection. Materials and Methods: We conducted a retrospective observational study of 18 patients who underwent ESD for superficial Barrett's neoplasia (dysplasia and early cancer) between January 2010 and December 2019 at Pusan National University Hospital. The therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection were performed in 94%, 72%, and 61% of patients, respectively. Histopathology (submucosal or deeper invasion of the tumor) was a significant predictive factor for incomplete resection (P=0.047). Procedure-related bleeding and stenosis were not observed, whereas perforation occurred in one case. During the median follow-up period of 12 months (range, 6-74 months), local recurrence occurred in 2 patients with incomplete resection, one patient underwent repeat ESD, and the other patient received concurrent chemoradiotherapy. The 3-year overall and disease-specific survival rates were 73% and 93%, respectively. Conclusions: ESD seems to be an effective and safe treatment for superficial Barrett's neoplasia in Korea. Nevertheless, the suitability of ESD for Barrett's cancer cases should be determined considering the high risk of deep submucosal invasion.
Keywords
Barrett's esophagus; Neoplasm; Endoscopic submucosal dissection; Adenocarcinoma;
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