Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer).

BACKGROUND

In view of the increasing incidence of adenocarcinoma in Barrett's esophagus and the mortality and high morbidity rates associated with surgical therapy for this condition, safe and effective but less invasive methods of treatment are needed.

OBJECTIVE

To evaluate efficacy and safety of endoscopic resection in these patients.

DESIGN

Single-center prospective study.

SETTING

Teaching hospital, conducted between October 1996 and September 2003.

PATIENTS

A total of 100 consecutive patients (mean age, 62.1 +/- 10.9 years; range, 31-86 years) with low-risk adenocarcinoma of the esophagus (macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion without invasion into lymph vessels and veins; and histologic grades G1 and G2) arising in Barrett's metaplasia.

INTERVENTIONS

Endoscopic resection with the suck-and-cut technique.

MAIN OUTCOME MEASUREMENTS

Complete local remission.

RESULTS

A total of 144 resections (1.47 per patient) were performed without technical problems. No major complications and only 11 minor ones (bleedings without decrease of Hb >2 g/dL; treated with injection therapy) occurred. Complete local remission was achieved in 99 of the 100 patients after 1.9 months (range, 1-18 months) and a maximum of 3 resections. During a mean follow-up period of 36.7 months, recurrent or metachronous carcinomas were found in 11% of the patients, but successful repeat treatment with endoscopic resection was possible in all of these cases. The calculated 5-year survival rate was 98%. Two patients died of other causes.

LIMITATIONS

Nonblinded, nonrandomized study.

CONCLUSIONS

Endoscopic resection is associated with favorable outcomes for low-risk patients with early esophageal adenocarcinoma (Barrett's carcinoma).