Effect of endoscopic submucosal dissection on histologic diagnosis in Barrett's esophagus visible neoplasia.

Autor: Yang D; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., King W; Department of Medicine, University of Florida, Gainesville, Florida, USA., Aihara H; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Karasik MS; Division of Gastroenterology and Hepatology, Hartford Hospital, Hartford, Connecticut, USA., Ngamruengphong S; Division of Gastroenterology and Hepatology, Johns Hopkins Medical Center, Baltimore, Maryland, USA., Aadam AA; Division of Gastroenterology and Hepatology, Northwestern Medicine Digestive Health Center, Chicago, Illinois, USA., Othman MO; Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA., Sharma N; Division of Interventional Endoscopic Oncology and Surgical Endoscopy (IOSE), Parkview Health, Fort Wayne, Indiana, USA., Grimm IS; Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA., Rostom A; Division of Gastroenterology and Hepatology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada., Elmunzer BJ; Division of Gastroenterology and Hepatology, The Medical University of South Carolina, Charleston, South Carolina, USA., Jawaid SA; Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA., Perbtani YB; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA., Hoffman BJ; Division of Gastroenterology and Hepatology, The Medical University of South Carolina, Charleston, South Carolina, USA., Akki AS; Department of Pathology Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA., Schlachterman A; Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA., Coman RM; Division of Hospital Gastroenterology, Atrium/Navicent Health, Mercer University, College of Medicine, Macon, Georgia, USA., Wang AY; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA., Draganov PV; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2022 Apr; Vol. 95 (4), pp. 626-633. Date of Electronic Publication: 2021 Dec 11.
DOI: 10.1016/j.gie.2021.11.046
Abstrakt: Background and Aims: Data are limited on the role of endoscopic submucosal dissection (ESD) as a potential diagnostic and staging tool in Barrett's esophagus (BE) neoplasia. We aimed to evaluate the frequency and factors associated with change of histologic diagnosis by ESD compared with pre-ESD histology.
Methods: This was a multicenter, prospective cohort study of patients who underwent ESD for BE visible neoplasia. A change in histologic diagnosis was defined as "upstaged" or "downstaged" if the ESD specimen had a higher or lower degree, respectively, of dysplasia or neoplasia when compared with pre-ESD specimens.
Results: Two hundred five patients (median age, 69 years; 81% men) with BE visible neoplasia underwent ESD from 2016 to 2021. Baseline histology was obtained using forceps (n = 182) or EMR (n = 23). ESD changed the histologic diagnosis in 55.1% of cases (113/205), of which 68.1% were upstaged and 31.9% downstaged. The frequency of change in diagnosis after ESD was similar whether baseline histology was obtained using forceps (55.5%) or EMR (52.2%) (P = .83). In aggregate, 23.9% of cases (49/205) were upstaged to invasive cancer on ESD histopathology. On multivariate analysis, lesions in the distal esophagus and gastroesophageal junction (odds ratio, 2.1; 95 confidence interval, 1.1-3.9; P = .02) and prior radiofrequency ablation (odds ratio, 2.5; 95% confidence interval, 1.2-5.5; P = .02) were predictors of change in histologic diagnosis.
Conclusions: ESD led to a change of diagnosis in more than half of patients with BE visible neoplasia. Selective ESD can serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease. (Clinical trial registration number: NCT02989818.).
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
Externí odkaz: