المتخصصون في المجالات الطبية

July 22, 2025

Endoscopic eradication therapy (EET) in patients with dysplastic Barrett's esophagus (BE) is achieved using endoscopic resection (ER) followed by endoscopic ablation. Currently, there are two available approaches to ER — endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

Mayo Clinic researchers have previously demonstrated that both ER approaches yield comparable rates of complete remission of intestinal metaplasia (CRIM). However, the availability of data demonstrating the rates of recurrence after CRIM associated with each of these ER approaches is limited. To address this knowledge gap, Mayo Clinic researchers and colleagues conducted a multicenter study comparing post-CRIM rates of recurrence in patients who underwent EMR versus ESD. The results of this study were published in The American Journal of Gastroenterology in 2024.

Methods

The researchers prospectively queried a database of all patients undergoing EET from 2006 to 2022 at one of three tertiary referral centers: Mayo Clinic in Rochester, Minnesota, and Cleveland Clinic and University Hospitals Cleveland Medical Center, both in Cleveland. They abstracted demographic and clinical data from 621 patients (514 receiving EMR and 107 receiving ESD) who achieved CRIM after undergoing either EMR or ESD plus ablation. Using Cox-proportional hazards models and inverse probability treatment weighting (IPTW) analysis, the researchers determined recurrence rates and identified predictors of any BE and dysplastic BE recurrence within the two treatment groups.

The ER approach used (EMR versus ESD) was chosen by the treating endoscopist. In general, most endoscopists performed ESD for patients with lesions larger than 1.5 to 2 cm in diameter. The median follow-up time after CRIM was 3.6 years in the EMR group and 1.3 years in the ESD group.

Results

Overall, the researchers observed that the technique used to achieve ER appears to have little influence over the incidence of BE recurrence or dysplastic BE recurrence.

• Incidence of any BE recurrence associated with the two ER techniques: 15.7 for EMR and 17.3 for ESD per 100 patient-years.
• Incidence of dysplastic BE recurrence: 7.3 for EMR and 5.3 for ESD per 100 patient-years.
• Multivariable analyses results adjusting for baseline clinical and histological variables suggest that the chance of BE recurrence is not influenced by ER technique. ESD versus EMR: hazard ratio, 0.87; 95% confidence interval, 0.51 to 1.49; P = 0.62.
• IPTW analysis results confirmed that the chance of BE recurrence was not associated with ER approach. ESD versus EMR: hazard ratio, 0.98; 95% confidence interval, 0.56 to 1.73; P = 0.94.

The researchers also identified several variables that were independent predictors of BE recurrence: BE length, larger lesion size and history of cigarette smoking.

"These data are critical in understanding the advantages of cap-assisted EMR over ESD in the initial management of patients with Barrett's esophagus-related dysplasia or esophageal neoplasia or adenocarcinoma," explains Prasad G. Iyer, M.D., M.S., a gastroenterologist and researcher at Mayo Clinic in Rochester, Minnesota, who served as the study publication's corresponding author.

"In this large multicenter cohort, we demonstrate that after initial cap-assisted EMR or ESD followed by endoscopic ablation, recurrence rates are comparable. Hence our results do not support using a difference in recurrence rates after achieving elimination of intestinal metaplasia as a reason to choose ESD over EMR."

Dr. Iyer and co-authors note that the next phase of research needed will be challenging to design and conduct. "Ideally, a randomized controlled trial between these modalities would provide definitive evidence," says Dr. Iyer.

For more information

Vantanasiri K, et al. Rates of recurrent intestinal metaplasia and dysplasia after successful endoscopic therapy of Barrett's neoplasia by endoscopic mucosal resection vs endoscopic submucosal dissection and ablation: A large North American multicenter cohort. The American Journal of Gastroenterology. 2024;119:1831.

Refer a patient to Mayo Clinic.