Margin clearance and post-procedure ablation decrease recurrence risk in endoscopic mucosal resections for Barrett's-related neoplasia.

AIMS: Endoscopic mucosal resection (EMR) is widely used for treating Barrett's-related oesophageal dysplasia and low-stage carcinoma. Disease can recur after this procedure. We analysed a large cohort of EMR specimens to assess clinical and histopathologic factors and their relationship to recurrence. METHODS AND RESULTS: We conducted a retrospective study of 129 patients who had in total 290 oesophageal EMRs for glandular neoplasia. Patient age, patient sex, specimen fragmentation, intestinal metaplasia, highest-grade lesion, margin status and clearance, cancer invasion depth, lymphovascular invasion, tumour budding (using published guidelines for colorectal carcinoma), post-procedure cryoablation/radiofrequency ablation and disease recurrence were recorded. Statistical analyses were performed on 227 eligible cases to determine the significance of these factors in local disease recurrence. Adenocarcinoma was the highest-grade lesion in 42% of the 290 specimens, high-grade dysplasia in 36% and low-grade dysplasia in 22%. Mean age at first EMR was 66 years. Among the 227 statistically analysed cases, post-procedure ablation was performed for 111 (49%) and recurrence of same or worse disease was documented in 104 (46%). Tumour depth and budding did not affect recurrence risk. On multivariate analysis, lack of post-procedure ablation was associated with increased recurrence risk for high-grade dysplasia and carcinoma. Additionally, poor differentiation and margin status were associated with increased recurrence risk for specimens with carcinoma. These relationships mostly held true for recurrence of same/worse neoplasia or recurrence of any neoplasia. CONCLUSIONS: Differentiation, margin status and post-EMR ablation influence the risk of local disease recurrence for Barrett's-related adenocarcinoma, while other factors such as tumour budding and lesional depth do not.

Duke Scholars

Author Wei Chen Pathology