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

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.