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Endoscopic Mucosal Resection Results in Change of Histologic Diagnosis in Barrett’s Esophagus Patients with Visible and Flat Neoplasia: A Multicenter Cohort Study

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Abstract

Background

There are limited data on the effect of endoscopic mucosal resection (EMR) on changes of histopathologic diagnosis for Barrett’s esophagus (BE) patients undergoing endoscopic eradication therapy (EET); especially those without visible lesions.

Aim

To compare the frequency of changes of diagnosis by EMR compared with pre-EMR biopsy diagnosis for patients with and without visible lesions.

Methods

In this multicenter outcomes project, patients with Barrett’s-related neoplasia undergoing EET at three tertiary-care centers were included. Patients undergoing biopsies followed by EMR within six months were included. The main outcome measures were frequency of overall change of histopathologic diagnosis, change based on pre-EMR biopsy diagnosis, and change based on the presence of visible lesions.

Results

One-hundred and thirty-eight BE patients (low-grade dysplasia (LGD) 15 (10.9 %), high-grade dysplasia (HGD) 87 (63 %), esophageal adenocarcinoma (EAC) 36 (26.1 %)) were included; 114 (82.6 %) patients had visible lesions. EMR resulted in a change of diagnosis for 43 (31.1 %) patients (upgrade 14 (10.1 %); downgrade 29 (21 %)). For HGD patients, EMR downstaged dysplasia grade for 17 (19.5 %) cases and upstaged it to EAC for nine (10.3 %) cases. There was a change of diagnosis for 26 (29.9 %) HGD patients, irrespective of the presence or absence of visible lesions (p = 0.76). For EAC patients, EMR downstaged dysplasia grade in 10 (27.8 %) cases. There was a change of diagnosis for 10 (27.8 %) EAC patients, irrespective of the presence or absence of endoscopically visible lesions (p = 0.48).

Conclusions

EMR results in a change of diagnosis for approximately 30 % of BE patients with early neoplasia (with and without visible lesions) referred for EET.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Colorado and Veterans Affairs Medical Center, Denver, CO, USA

    Sachin Wani

  2. Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, MO, USA

    Steven A. Edmundowicz, Srinivas Gaddam, Christine E. Hovis & Dayna Early

  3. Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Julian Abrams, Daniel Green & Charles J. Lightdale

  4. Division of Gastroenterology and Hepatology, Department of Veterans Affairs Medical Center and University of Kansas School of Medicine, 4801 E. Linwood Blvd, Kansas City, MO, 64128-2295, USA

    Neil Gupta, April Higbee, Ajay Bansal, Amit Rastogi & Prateek Sharma

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  1. Sachin Wani
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  2. Julian Abrams
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Correspondence to Prateek Sharma.

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Wani, S., Abrams, J., Edmundowicz, S.A. et al. Endoscopic Mucosal Resection Results in Change of Histologic Diagnosis in Barrett’s Esophagus Patients with Visible and Flat Neoplasia: A Multicenter Cohort Study. Dig Dis Sci 58, 1703–1709 (2013). https://doi.org/10.1007/s10620-013-2689-7

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  • DOI: https://doi.org/10.1007/s10620-013-2689-7

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