Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: An Italian experience

Massimo Conio, Alessandro Repici, Renzo Cestari, Sabrina Blanchi, Gabriella Lapertosa, Guido Missale, Domenico Della Casa, Vincenzo Villanacci, Pier Gigi Calandri, Rosangela Filiberti

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Aim: To evaluate endoscopic mucosal resection (EMR) in patients with high-grade dysplasia (HGD) and/or intramucosal cancer (IMC) in Barrett's esophagus (BE). Methods: Between June 2000 and December 2003, 39 consecutive patients with HGD (35) and/or IMC (4) underwent EMR. BE >30 mm was present in 27 patients. In three patients with short segment BE (25.0%), HGD was detected in a normal appearing BE. Lesions had a mean diameter of 14.8±10.3 mm. Mucosal resection was carried out using the cap method. Results: The average size of resections was 19.7± 9.4×14.6±8.2 mm. Histopathologic assessment post-resection revealed 5 low-grade dysplasia (LGD) (12.8%), 27 HGD (69.2%), 2 IMC (5.1%), and 5 SMC (-12.8%). EMR changed the pre-treatment diagnosis in 10 patients (25.6%). Three patients with SMC underwent surgery. Histology of the surgical specimen revealed 1 T0N0 and 2 T1N0 lesions. The remaining two patients were cancer free at 32.5 and 45.6 mo, respectively. A metachronous lesion was detected after 25 mo in one patient with HGD. Intra-procedural bleeding, controlled at endoscopy, occurred in four patients (10.3%). After a median follow-up of 34.9 mo, all patients remained in remission. Conclusion: In the medium term, EMR is effective and safe to treat HGD and/or IMC within BE and is a valuable staging method. It could become an alternative to surgery.

Original languageEnglish
Pages (from-to)6650-6655
Number of pages6
JournalWorld Journal of Gastroenterology
Issue number42
Publication statusPublished - Nov 14 2005


  • Barrett's esophagus
  • Endoscopic mucosal resection
  • High-grade dysplasia
  • Intramucosal cancer

ASJC Scopus subject areas

  • Gastroenterology


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