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Tu1576 Single and Sequential Biodegradable Stent Placement for Refractory Benign Esophageal Strictures: A Prospective Follow-Up Study
Abstracts
or without vomiting (n⫽6), hemorrhage (n⫽3), fever (n⫽1) and aspiration pneumonia (n⫽1). Major complications were most common after initial stent (n⫽8) versus second (n⫽1) and third stent placement (n⫽2). Minor complications included mild retrosternal pain, reflux or vomiting in 4 (15%) patients. Conclusion: In a severely refractory patient population seen in a highly specialized endoscopy unit, single BD stent placement is only temporarily effective. Sequential BD stenting may be an option to avoid serial dilation, but the relatively high complication rate and modest clinical efficacy should be considered carefully in each patient prior to BD stent placement.
Tu1577 Analysis of One Hundred and Five Consecutive Lesions of Endoscopic Submucosal Dissection for Esophageal Superficial Neoplasms Masamitsu Nakao*, Shin Arai, Miho Matsukawa, Yasutoshi Ochiai, Takashi Shono, Osamu Togawa, Makoto Nishimura, Keiko Ishikawa, Hiroto Kita Gastroenterology, International Medical Center, Saitama Medical University, Saitama, Japan
disease progression, and adverse events. Results: 32 PTs were enrolled, including 29 men (91%), 31 Caucasian (97%). Median age was 60.5 yrs (range 36-78), median segment length was 3 cm (range 1-9), and median treatment number was 4 (IQR 3-5). Six PTs received ER prior to LN-cryo. Median follow-up was 37 months (range 24-57). At 2 yrs, CR-HGD was 32/32 (100%), CR-IM was 27/32 (84.4%). At last follow-up, CR-HGD was 31/32 (97%), CR-IM was 26/32 (81%). Retreatment was needed in 12 (36%) due to recurrence of IM (7) or HGD (5) in the esophagus (4) or NSCJ (8). One PT progressed to adenocarcinoma, treated with ER and repeat LN-cryo but has persistent focal HGD. Median time to recurrence of HGD was 6 months. After retreatment, CR-HGD was successful in 4/5 (80%), CR-IM in 5/12 (42%). Logistic regression showed no association between recurrence of HGD or IM and segment length (p⫽0.45) or number of treatments (p⫽0.79). No serious adverse events occurred. Stricture was seen in 6% (2/32), all successfully dilated. Conclusions: In PTs with BE and HGD, LNcryo has an acceptable safety profile, durability of response, and is associated with a low rate of recurrence or progression to cancer with long-term follow-up.
Tu1576 Single and Sequential Biodegradable Stent Placement for Refractory Benign Esophageal Strictures: A Prospective FollowUp Study Meike M. Hirdes*, Peter D. Siersema, Petra G. Van Boeckel, Frank P. Vleggaar Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands Background and Aim: Refractory benign esophageal strictures (RBES) can be treated with fully covered metal or plastic stents. A major drawback of these stents is the need for stent removal, which can be avoided by placement of recently developed biodegradable (BD) stents (Ella-CS, Hradec-Kralove, Czech Republic) stent. Refractory patients, however, often need multiple stent placements to become dysphagia free. The aim of the study is to assess long term efficacy and safety of single and sequential BD stent placements in patients with RBES. Methods: All consecutive patients who underwent BD stent placement for RBES between august 2008 and March 2011 were contacted 14 days after treatment and monthly thereafter. Data was collected with respect to technical and clinical success (defined as absence of dysphagia ⱖ6 months after stent placement), recurrent dysphagia and complications. Results: In total, 59 BD stents were placed in 28 patients (15 males, median age 58 years (22-88)) for peptic (n⫽9), anastomotic (n⫽6), corrosive (n⫽4), radiotherapy-induced (n⫽4), lichen planus (n⫽1) and other (n⫽4) strictures. Patients had previously been treated with multiple dilations (n⫽20) or multiple dilations and non-BD esophageal stenting (n⫽8). Fifteen patients underwent single BD stent placement, 13 patients underwent sequential BD stent placements (median 3, range 2-8) during the study period. After initial stent placement, median dysphagia free period was 90 days (range 14-618) and clinical success (absence of dysphagia ⱖ6 months after stent placement) was achieved in 7 (25%) patients. After second BD stent placement, median dysphagia free period was 55 days (25-700) days and clinical success was achieved in 2 (15%) patients. After third stent placement, median dysphagia free period was 106 (range 90-150) days, but none of the patients achieved clinical success. In total, 8 (29%) patients developed 11 major complications, which included severe retrosternal pain with
Background and Aims: An increasing number of patients with esophageal superficial neoplasms have been detected by using new diagnostic endoscopic technologies, including magnifying endoscopy and image-enhanced endoscopy. The future demand for endoscopic submucosal dissection is expected to increase because this is minimally invasive treatment. There are still few reports on the feasibility of endoscopic submucosal dissection for esophageal superficial neoplasms. We retrospectively evaluated the efficacy of endoscopic submucosal dissection for esophageal superficial neoplasms from our over one hundred consecutive lesions. Patients and Methods: From April 2007 to August 2011, 105 lesions in 85 enrolled patients were treated by endoscopic submucosal dissection for esophageal superficial neoplasms. The therapeutic efficacy, complication, and follow up results were evaluated. Results: The mean size of the specimens was 30.9⫾11.5 mm (range 8-70 mm). The rates of en block resection and complete resection were 95.2% (100/105) and 75.2% (79/105), respectively. Discontinued cases were 5 (4.8%). The reasons for the discontinuation included fibrosis due to previous radiation therapy in 2 cases, fibrosis due to previous endoscopic therapy for adjacent lesion in 1 case, difficult location of the tumor (inside of the diverticulum) in 1 case, and deep submucosal invasion of the tumor in 1 case. Histologically, 102 cases were squamous cell carcinoma and 3 cases were adenocarcinoma, respectively. For 100 lesions of en block resection, the number of histological depth in lesions with EP, LPM, MM, SM1, and SM2 were 33, 41, 14, 5, and 7, respectively. Further therapy were additionally chosen in 11 patients including surgical esophagectomy in 3 cases, chemo-radiation therapy in 2 cases, radiation therapy in 2 cases, and argon plasma coagulation therapy in 4 cases. Perforation accompanied by mediastinal emphysema occurred in 1 (0.9%) case who was managed by conservative medical treatment. None of the patients experienced significant bleeding. Five (4.7%) patients who had benign esophageal stricture after the endoscopic dissection, were successfully managed by balloon dilatation. During the mean observation period of 617 days (range 22-1613), one patient who discontinued endoscopic dissection due to massive submucosal invasion and additionally received radiation therapy, died of esophageal carcinoma after 572 days. Three patients died of another disease. None of the other patients developed local recurrence or distant metastasis. The overall survival rates of 1 year and 3 years were 98.7% and 92.2%, respectively. Conclusion: This study suggests that endoscopic submucosal resection is a safe and potentially curative treatment for esophageal superficial neoplasms.
Tu1578 Comparison of Esophagectomy vs. Endoscopic Mucosal Resection for Early Neoplastic Barrett’s Esophagus Jason Lewis*1, Cyrus R. Piraka1, Andrew C. Chang2, B. J. Elmunzer1, Richard S. Kwon1, Joel H. Rubenstein1 1 Internal Medicine, University of Michigan, Ann Arbor, MI; 2Thoracic Surgery, University of Michigan, Ann Arbor, MI Background: Esophagectomy traditionally has been regarded as the standard treatment option for Barrett’s esophagus with high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We hypothesized that endoscopic mucosal resection (EMR) of HGD or intramucosal cancer (IMC) is associated with fewer complications and similar survival compared with esophagectomy. Methods: We retrospectively reviewed the records of 234 patients who underwent esophagectomy between 1994-2010 for treatment of Barrett’s esophagus with HGD or IMC and 77 patients who underwent EMR from 2006-2010 for the same indication. Chi-square test was used to compare complications. Survival and time to recurrence were compared using life table analysis and Cox proportional hazards, adjusting for age and combordities. Results: Of the 77 patients who underwent EMR for an indication of HGD or IMC, 15 (19%) were found to have low-grade dysplasia (LGD) or non-dysplastic BE on final pathology, 33 (43%) HGD, and 29 (38%) IMC. Of the surgery patients, 135 (58%) had HGD and 99
AB452 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
or without vomiting (n⫽6), hemorrhage (n⫽3), fever (n⫽1) and aspiration pneumonia (n⫽1). Major complications were most common after initial stent (n⫽8) versus second (n⫽1) and third stent placement (n⫽2). Minor complications included mild retrosternal pain, reflux or vomiting in 4 (15%) patients. Conclusion: In a severely refractory patient population seen in a highly specialized endoscopy unit, single BD stent placement is only temporarily effective. Sequential BD stenting may be an option to avoid serial dilation, but the relatively high complication rate and modest clinical efficacy should be considered carefully in each patient prior to BD stent placement.
Tu1577 Analysis of One Hundred and Five Consecutive Lesions of Endoscopic Submucosal Dissection for Esophageal Superficial Neoplasms Masamitsu Nakao*, Shin Arai, Miho Matsukawa, Yasutoshi Ochiai, Takashi Shono, Osamu Togawa, Makoto Nishimura, Keiko Ishikawa, Hiroto Kita Gastroenterology, International Medical Center, Saitama Medical University, Saitama, Japan
disease progression, and adverse events. Results: 32 PTs were enrolled, including 29 men (91%), 31 Caucasian (97%). Median age was 60.5 yrs (range 36-78), median segment length was 3 cm (range 1-9), and median treatment number was 4 (IQR 3-5). Six PTs received ER prior to LN-cryo. Median follow-up was 37 months (range 24-57). At 2 yrs, CR-HGD was 32/32 (100%), CR-IM was 27/32 (84.4%). At last follow-up, CR-HGD was 31/32 (97%), CR-IM was 26/32 (81%). Retreatment was needed in 12 (36%) due to recurrence of IM (7) or HGD (5) in the esophagus (4) or NSCJ (8). One PT progressed to adenocarcinoma, treated with ER and repeat LN-cryo but has persistent focal HGD. Median time to recurrence of HGD was 6 months. After retreatment, CR-HGD was successful in 4/5 (80%), CR-IM in 5/12 (42%). Logistic regression showed no association between recurrence of HGD or IM and segment length (p⫽0.45) or number of treatments (p⫽0.79). No serious adverse events occurred. Stricture was seen in 6% (2/32), all successfully dilated. Conclusions: In PTs with BE and HGD, LNcryo has an acceptable safety profile, durability of response, and is associated with a low rate of recurrence or progression to cancer with long-term follow-up.
Tu1576 Single and Sequential Biodegradable Stent Placement for Refractory Benign Esophageal Strictures: A Prospective FollowUp Study Meike M. Hirdes*, Peter D. Siersema, Petra G. Van Boeckel, Frank P. Vleggaar Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands Background and Aim: Refractory benign esophageal strictures (RBES) can be treated with fully covered metal or plastic stents. A major drawback of these stents is the need for stent removal, which can be avoided by placement of recently developed biodegradable (BD) stents (Ella-CS, Hradec-Kralove, Czech Republic) stent. Refractory patients, however, often need multiple stent placements to become dysphagia free. The aim of the study is to assess long term efficacy and safety of single and sequential BD stent placements in patients with RBES. Methods: All consecutive patients who underwent BD stent placement for RBES between august 2008 and March 2011 were contacted 14 days after treatment and monthly thereafter. Data was collected with respect to technical and clinical success (defined as absence of dysphagia ⱖ6 months after stent placement), recurrent dysphagia and complications. Results: In total, 59 BD stents were placed in 28 patients (15 males, median age 58 years (22-88)) for peptic (n⫽9), anastomotic (n⫽6), corrosive (n⫽4), radiotherapy-induced (n⫽4), lichen planus (n⫽1) and other (n⫽4) strictures. Patients had previously been treated with multiple dilations (n⫽20) or multiple dilations and non-BD esophageal stenting (n⫽8). Fifteen patients underwent single BD stent placement, 13 patients underwent sequential BD stent placements (median 3, range 2-8) during the study period. After initial stent placement, median dysphagia free period was 90 days (range 14-618) and clinical success (absence of dysphagia ⱖ6 months after stent placement) was achieved in 7 (25%) patients. After second BD stent placement, median dysphagia free period was 55 days (25-700) days and clinical success was achieved in 2 (15%) patients. After third stent placement, median dysphagia free period was 106 (range 90-150) days, but none of the patients achieved clinical success. In total, 8 (29%) patients developed 11 major complications, which included severe retrosternal pain with
Background and Aims: An increasing number of patients with esophageal superficial neoplasms have been detected by using new diagnostic endoscopic technologies, including magnifying endoscopy and image-enhanced endoscopy. The future demand for endoscopic submucosal dissection is expected to increase because this is minimally invasive treatment. There are still few reports on the feasibility of endoscopic submucosal dissection for esophageal superficial neoplasms. We retrospectively evaluated the efficacy of endoscopic submucosal dissection for esophageal superficial neoplasms from our over one hundred consecutive lesions. Patients and Methods: From April 2007 to August 2011, 105 lesions in 85 enrolled patients were treated by endoscopic submucosal dissection for esophageal superficial neoplasms. The therapeutic efficacy, complication, and follow up results were evaluated. Results: The mean size of the specimens was 30.9⫾11.5 mm (range 8-70 mm). The rates of en block resection and complete resection were 95.2% (100/105) and 75.2% (79/105), respectively. Discontinued cases were 5 (4.8%). The reasons for the discontinuation included fibrosis due to previous radiation therapy in 2 cases, fibrosis due to previous endoscopic therapy for adjacent lesion in 1 case, difficult location of the tumor (inside of the diverticulum) in 1 case, and deep submucosal invasion of the tumor in 1 case. Histologically, 102 cases were squamous cell carcinoma and 3 cases were adenocarcinoma, respectively. For 100 lesions of en block resection, the number of histological depth in lesions with EP, LPM, MM, SM1, and SM2 were 33, 41, 14, 5, and 7, respectively. Further therapy were additionally chosen in 11 patients including surgical esophagectomy in 3 cases, chemo-radiation therapy in 2 cases, radiation therapy in 2 cases, and argon plasma coagulation therapy in 4 cases. Perforation accompanied by mediastinal emphysema occurred in 1 (0.9%) case who was managed by conservative medical treatment. None of the patients experienced significant bleeding. Five (4.7%) patients who had benign esophageal stricture after the endoscopic dissection, were successfully managed by balloon dilatation. During the mean observation period of 617 days (range 22-1613), one patient who discontinued endoscopic dissection due to massive submucosal invasion and additionally received radiation therapy, died of esophageal carcinoma after 572 days. Three patients died of another disease. None of the other patients developed local recurrence or distant metastasis. The overall survival rates of 1 year and 3 years were 98.7% and 92.2%, respectively. Conclusion: This study suggests that endoscopic submucosal resection is a safe and potentially curative treatment for esophageal superficial neoplasms.
Tu1578 Comparison of Esophagectomy vs. Endoscopic Mucosal Resection for Early Neoplastic Barrett’s Esophagus Jason Lewis*1, Cyrus R. Piraka1, Andrew C. Chang2, B. J. Elmunzer1, Richard S. Kwon1, Joel H. Rubenstein1 1 Internal Medicine, University of Michigan, Ann Arbor, MI; 2Thoracic Surgery, University of Michigan, Ann Arbor, MI Background: Esophagectomy traditionally has been regarded as the standard treatment option for Barrett’s esophagus with high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We hypothesized that endoscopic mucosal resection (EMR) of HGD or intramucosal cancer (IMC) is associated with fewer complications and similar survival compared with esophagectomy. Methods: We retrospectively reviewed the records of 234 patients who underwent esophagectomy between 1994-2010 for treatment of Barrett’s esophagus with HGD or IMC and 77 patients who underwent EMR from 2006-2010 for the same indication. Chi-square test was used to compare complications. Survival and time to recurrence were compared using life table analysis and Cox proportional hazards, adjusting for age and combordities. Results: Of the 77 patients who underwent EMR for an indication of HGD or IMC, 15 (19%) were found to have low-grade dysplasia (LGD) or non-dysplastic BE on final pathology, 33 (43%) HGD, and 29 (38%) IMC. Of the surgery patients, 135 (58%) had HGD and 99
AB452 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org