Endotherapy for superficial adenocarcinoma of the esophagus: An American experience

Background: EMR and ablation are increasingly being used alone or in combination for treatment of Barrett's neoplasia. Given a very low rate of lymph node metastasis, endotherapy has become an accepted treatment option for T1a esophageal adenocarcinoma (EAC) with low-risk features. Objective: To report our experience of endoscopic management of T1a EAC in a large, tertiary-care center. Design: Retrospective review. Setting: Tertiary-care referral center. Patients: Patients treated endoscopically for low-risk T1a EAC at our center. Intervention: EMR and endoscopic ablation. Main Outcome Measurements: Death related to esophageal cancer, remission of adenocarcinoma, dysplasia, and intestinal metaplasia. Results: A total of 54 patients underwent endotherapy for low-risk T1a EAC from 2006 to 2012. Mean (± SD) follow-up was 23 (± 16) months, mean (± SD) size of resected adenocarcinoma was 7.1 (± 4.3) mm, and mean (± SD) Barrett's esophagus length was 4.5 (± 3.9) cm. Band-assisted, cap-assisted, and lift and cut EMR were performed in 85%, 11%, and 4% of patients, respectively; 81% underwent additional ablative therapy (radiofrequency ablation 95%, cryotherapy 9%, photodynamic therapy 2%). Complete remission from cancer was achieved in 96%, complete remission from dysplasia in 87%, and complete remission from intestinal metaplasia in 59%. The overall survival was 89%; there were no deaths related to esophageal cancer. Limitations: Retrospective study. Conclusion: Endotherapy for T1a EAC was safe and effective in our American cohort. Endotherapy should be considered primary therapy for appropriate patients with low-risk lesions. Complete Barrett's esophagus eradication after EMR is important to reduce the development of metachronous lesions.