Endoscopic mucosal or submucosal resection of early neoplasia in Barrett's esophagus after antireflux surgery

BACKGROUND: Endoscopic resection and radiofrequency ablation are now established therapies for high-grade intraepithelial neoplasia and mucosal cancer complicating Barrett's esophagus. These techniques may be more challenging in patients with previous antireflux surgery, because of poor visibility and accessibility. OBJECTIVE: To assess the results of endoscopic resection for early neoplasia complicating Barrett's esophagus after antireflux surgery. DESIGN: Case series, retrospective review. SETTING: Single tertiary-care referral center. PATIENTS: This study involved 7 patients treated for Barrett's neoplasia by endoscopic resection between 2001 and 2009. INTERVENTIONS: Endoscopic resection was performed by using the EMR cap technique or by endoscopic submucosal dissection. MAIN OUTCOME MEASUREMENTS: The curative resection rate, complications, follow-up, and complete remission status were determined. RESULTS: Seven patients underwent endoscopic resection (mean number of sessions, 3.1; range, 1-6): endoscopic submucosal dissection in 3 patients and EMR in 4 patients. Two patients needed additional argon plasma coagulation. Pathology examination disclosed invasive adenocarcinoma in 3 patients and high-grade intraepithelial neoplasia in 4 patients. At the last follow-up examination, all patients were in complete remission. Major procedure-related complications were not encountered. LIMITATIONS: Small number of patients, single center, retrospective study. CONCLUSIONS: We demonstrated that full endoscopic resection by using EMR or endoscopic submucosal dissection in patients with previous antireflux surgery can be achieved successfully and safely. These patients can be treated endoscopically, similarly to patients without previous surgery.