Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen

Translated title of the contribution: Single-Center-Experience with endoscopic submucosal dissection (ESD) with early Barrett's carcinoma

S. Höbel, R. Baumbach, P. Dautel, K. J. Oldhafer, A. Stang, B. Feyerabend, Naohisa Yahagi, S. Faiss

Research output: Contribution to journalArticle

Abstract

Introduction: So far endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett's adenocarcinoma. Endoscopic submucosal dissection (ESD) of neoplastic lesions of the gastrointestinal tract is a rather new endoscopic technique, which was developed in Japan and becomes increasing importance. The ESD allows in contrast to EMR an endoscopic en-bloc resection of lesions greater than 2cm with a complete histological evaluation of the resected specimen. In Germany the experience with ESD in patients with early Barrett's carcinoma is still limited. Therefore the aim of the present study is to describe the results of 34 ESDs in patients with early Barrett's carcinoma performed in a German tertiary referral center. Material and methods: Between November 2009 and August 2015 ESDs were performed in 34 patients (30 men, 4 women; mean age 63.52 years) with histologically proven Barrett's adenocarcinoma. Data were given for the en-bloc, the R0, the R0 en-bloc and the curative resection rate as well as for the complication and the local recurrence rate after a follow-up period. Results: ESD was technically possible in all of the 34 patients. Thirty of the resected neoplastic lesions showed an adenocarcinoma limited to the mucosa. Of these lesions, 24 were histopathologically defined as well-differentiated adenocarcinoma and 6 as moderately differentiated adenocarcinoma based on a Barrett's mucosa. In contrast only 4 of the resected lesions showed an adenocarcinoma with submucosal invasion. 2 were histopathologically defined as well-differentiated adenocarcinoma and 2 as moderately differentiated adenocarcinoma. The en-bloc, R0, R0 en-bloc and curative resection rates were 97.1%, 85.3%, 85.3% resp.76.5%. Complication rate was 17.6% (perforation n=1, delayed bleeding n=2, esophageal stenosis n=3). In case of curative tumor resection only 2 local tumor recurrence (8%) occurred after a medium follow-up of 1.68 years. Discussion: Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD especially in case of curative resections in the definite as well as less invasive therapy of early Barretts carcinoma. Special attention should be drawn towards subsquamous extension of Barretts adenocarcinoma requiring a sufficient safety margin as an obligate condition for tumor-free lateral resection margins. Due to the required learning curve and the management of potential complications ESD should be restricted to greater endoscopic centers.

Original languageGerman
Pages (from-to)132-138
Number of pages7
JournalEndoskopie Heute
Volume28
Issue number2
DOIs
Publication statusPublished - 2015 Nov 1

Fingerprint

Adenocarcinoma
Carcinoma
Mucous Membrane
Endoscopic Mucosal Resection
Recurrence
Esophageal Stenosis
Neoplasms
Learning Curve
Tertiary Care Centers
Germany
Gastrointestinal Tract
Japan
Hemorrhage
Safety
Therapeutics

Keywords

  • early Barrett's carcinoma
  • endoscopic submucosal dissection
  • endoscopic tumor resection
  • ESD

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Höbel, S., Baumbach, R., Dautel, P., Oldhafer, K. J., Stang, A., Feyerabend, B., ... Faiss, S. (2015). Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen. Endoskopie Heute, 28(2), 132-138. https://doi.org/10.1055/s-0035-1553913

Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen. / Höbel, S.; Baumbach, R.; Dautel, P.; Oldhafer, K. J.; Stang, A.; Feyerabend, B.; Yahagi, Naohisa; Faiss, S.

In: Endoskopie Heute, Vol. 28, No. 2, 01.11.2015, p. 132-138.

Research output: Contribution to journalArticle

Höbel, S, Baumbach, R, Dautel, P, Oldhafer, KJ, Stang, A, Feyerabend, B, Yahagi, N & Faiss, S 2015, 'Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen', Endoskopie Heute, vol. 28, no. 2, pp. 132-138. https://doi.org/10.1055/s-0035-1553913
Höbel S, Baumbach R, Dautel P, Oldhafer KJ, Stang A, Feyerabend B et al. Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen. Endoskopie Heute. 2015 Nov 1;28(2):132-138. https://doi.org/10.1055/s-0035-1553913
Höbel, S. ; Baumbach, R. ; Dautel, P. ; Oldhafer, K. J. ; Stang, A. ; Feyerabend, B. ; Yahagi, Naohisa ; Faiss, S. / Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen. In: Endoskopie Heute. 2015 ; Vol. 28, No. 2. pp. 132-138.
@article{418c15e402654df5817416007122af7c,
title = "Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Fr{\"u}hkarzinomen",
abstract = "Introduction: So far endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett's adenocarcinoma. Endoscopic submucosal dissection (ESD) of neoplastic lesions of the gastrointestinal tract is a rather new endoscopic technique, which was developed in Japan and becomes increasing importance. The ESD allows in contrast to EMR an endoscopic en-bloc resection of lesions greater than 2cm with a complete histological evaluation of the resected specimen. In Germany the experience with ESD in patients with early Barrett's carcinoma is still limited. Therefore the aim of the present study is to describe the results of 34 ESDs in patients with early Barrett's carcinoma performed in a German tertiary referral center. Material and methods: Between November 2009 and August 2015 ESDs were performed in 34 patients (30 men, 4 women; mean age 63.52 years) with histologically proven Barrett's adenocarcinoma. Data were given for the en-bloc, the R0, the R0 en-bloc and the curative resection rate as well as for the complication and the local recurrence rate after a follow-up period. Results: ESD was technically possible in all of the 34 patients. Thirty of the resected neoplastic lesions showed an adenocarcinoma limited to the mucosa. Of these lesions, 24 were histopathologically defined as well-differentiated adenocarcinoma and 6 as moderately differentiated adenocarcinoma based on a Barrett's mucosa. In contrast only 4 of the resected lesions showed an adenocarcinoma with submucosal invasion. 2 were histopathologically defined as well-differentiated adenocarcinoma and 2 as moderately differentiated adenocarcinoma. The en-bloc, R0, R0 en-bloc and curative resection rates were 97.1{\%}, 85.3{\%}, 85.3{\%} resp.76.5{\%}. Complication rate was 17.6{\%} (perforation n=1, delayed bleeding n=2, esophageal stenosis n=3). In case of curative tumor resection only 2 local tumor recurrence (8{\%}) occurred after a medium follow-up of 1.68 years. Discussion: Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD especially in case of curative resections in the definite as well as less invasive therapy of early Barretts carcinoma. Special attention should be drawn towards subsquamous extension of Barretts adenocarcinoma requiring a sufficient safety margin as an obligate condition for tumor-free lateral resection margins. Due to the required learning curve and the management of potential complications ESD should be restricted to greater endoscopic centers.",
keywords = "early Barrett's carcinoma, endoscopic submucosal dissection, endoscopic tumor resection, ESD",
author = "S. H{\"o}bel and R. Baumbach and P. Dautel and Oldhafer, {K. J.} and A. Stang and B. Feyerabend and Naohisa Yahagi and S. Faiss",
year = "2015",
month = "11",
day = "1",
doi = "10.1055/s-0035-1553913",
language = "German",
volume = "28",
pages = "132--138",
journal = "Endoskopie Heute",
issn = "0933-811X",
publisher = "Georg Thieme Verlag",
number = "2",

}

TY - JOUR

T1 - Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen

AU - Höbel, S.

AU - Baumbach, R.

AU - Dautel, P.

AU - Oldhafer, K. J.

AU - Stang, A.

AU - Feyerabend, B.

AU - Yahagi, Naohisa

AU - Faiss, S.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Introduction: So far endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett's adenocarcinoma. Endoscopic submucosal dissection (ESD) of neoplastic lesions of the gastrointestinal tract is a rather new endoscopic technique, which was developed in Japan and becomes increasing importance. The ESD allows in contrast to EMR an endoscopic en-bloc resection of lesions greater than 2cm with a complete histological evaluation of the resected specimen. In Germany the experience with ESD in patients with early Barrett's carcinoma is still limited. Therefore the aim of the present study is to describe the results of 34 ESDs in patients with early Barrett's carcinoma performed in a German tertiary referral center. Material and methods: Between November 2009 and August 2015 ESDs were performed in 34 patients (30 men, 4 women; mean age 63.52 years) with histologically proven Barrett's adenocarcinoma. Data were given for the en-bloc, the R0, the R0 en-bloc and the curative resection rate as well as for the complication and the local recurrence rate after a follow-up period. Results: ESD was technically possible in all of the 34 patients. Thirty of the resected neoplastic lesions showed an adenocarcinoma limited to the mucosa. Of these lesions, 24 were histopathologically defined as well-differentiated adenocarcinoma and 6 as moderately differentiated adenocarcinoma based on a Barrett's mucosa. In contrast only 4 of the resected lesions showed an adenocarcinoma with submucosal invasion. 2 were histopathologically defined as well-differentiated adenocarcinoma and 2 as moderately differentiated adenocarcinoma. The en-bloc, R0, R0 en-bloc and curative resection rates were 97.1%, 85.3%, 85.3% resp.76.5%. Complication rate was 17.6% (perforation n=1, delayed bleeding n=2, esophageal stenosis n=3). In case of curative tumor resection only 2 local tumor recurrence (8%) occurred after a medium follow-up of 1.68 years. Discussion: Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD especially in case of curative resections in the definite as well as less invasive therapy of early Barretts carcinoma. Special attention should be drawn towards subsquamous extension of Barretts adenocarcinoma requiring a sufficient safety margin as an obligate condition for tumor-free lateral resection margins. Due to the required learning curve and the management of potential complications ESD should be restricted to greater endoscopic centers.

AB - Introduction: So far endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett's adenocarcinoma. Endoscopic submucosal dissection (ESD) of neoplastic lesions of the gastrointestinal tract is a rather new endoscopic technique, which was developed in Japan and becomes increasing importance. The ESD allows in contrast to EMR an endoscopic en-bloc resection of lesions greater than 2cm with a complete histological evaluation of the resected specimen. In Germany the experience with ESD in patients with early Barrett's carcinoma is still limited. Therefore the aim of the present study is to describe the results of 34 ESDs in patients with early Barrett's carcinoma performed in a German tertiary referral center. Material and methods: Between November 2009 and August 2015 ESDs were performed in 34 patients (30 men, 4 women; mean age 63.52 years) with histologically proven Barrett's adenocarcinoma. Data were given for the en-bloc, the R0, the R0 en-bloc and the curative resection rate as well as for the complication and the local recurrence rate after a follow-up period. Results: ESD was technically possible in all of the 34 patients. Thirty of the resected neoplastic lesions showed an adenocarcinoma limited to the mucosa. Of these lesions, 24 were histopathologically defined as well-differentiated adenocarcinoma and 6 as moderately differentiated adenocarcinoma based on a Barrett's mucosa. In contrast only 4 of the resected lesions showed an adenocarcinoma with submucosal invasion. 2 were histopathologically defined as well-differentiated adenocarcinoma and 2 as moderately differentiated adenocarcinoma. The en-bloc, R0, R0 en-bloc and curative resection rates were 97.1%, 85.3%, 85.3% resp.76.5%. Complication rate was 17.6% (perforation n=1, delayed bleeding n=2, esophageal stenosis n=3). In case of curative tumor resection only 2 local tumor recurrence (8%) occurred after a medium follow-up of 1.68 years. Discussion: Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD especially in case of curative resections in the definite as well as less invasive therapy of early Barretts carcinoma. Special attention should be drawn towards subsquamous extension of Barretts adenocarcinoma requiring a sufficient safety margin as an obligate condition for tumor-free lateral resection margins. Due to the required learning curve and the management of potential complications ESD should be restricted to greater endoscopic centers.

KW - early Barrett's carcinoma

KW - endoscopic submucosal dissection

KW - endoscopic tumor resection

KW - ESD

UR - http://www.scopus.com/inward/record.url?scp=84949742618&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84949742618&partnerID=8YFLogxK

U2 - 10.1055/s-0035-1553913

DO - 10.1055/s-0035-1553913

M3 - Article

AN - SCOPUS:84949742618

VL - 28

SP - 132

EP - 138

JO - Endoskopie Heute

JF - Endoskopie Heute

SN - 0933-811X

IS - 2

ER -