Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Barrett's Neoplasia: Clinical Outcomes at a Canadian Tertiary Referral Center
Notice bibliographique
Résumé
Aims Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for endoscopic resection of Barrett’s neoplasia, but consensus is lacking for which offers superior outcomes. This study compares the outcomes of EMR and ESD at a Canadian tertiary Barrett’s referral center. Methods A retrospective single-center study at St. Michael’s Hospital, Toronto, included patients treated for Barrett’s neoplasia (high-grade dysplasia or esophageal adenocarcinoma) from January 2015 to August 2023. Primary outcome was local recurrence after complete remission of dysplasia (CRD), with secondary outcomes being persistent dysplasia at the first follow-up and CRD achievement. Follow-up was performed until November 2023. Results The study included 331 patients: 72 underwent ESD and 259 underwent EMR (mean age: 68.5 y/o, 90.3% male in ESD, 67.6 y/o, 80.3% male in EMR). ESD group had larger lesions (4.5 vs 3.0cm, P<0.05) and higher circumferential occupancy (53.4% vs 43.0%, P<0.05). Adverse events were slightly more common in ESD (bleeding: 2.8% vs 0.4%, perforation: 1.4% vs 0.8%, P=0.15). Histologically, adenocarcinoma was more prevalent in ESD (94.4% vs 77.2%, P<0.05), with higher incidence of deep submucosal invasion (M: 75% vs 82% SM1: 6% vs13%, SM2: 19% vs 6%, P<0.05). Curative resection rates were 63.9% for ESD and 87.3% for EMR (defined as the absence of high-risk pathologic features for lymph node metastasis regardless of the vertical margin). Of the 275 patients who underwent follow-up (54 ESD, 221 EMR), persistent dysplasia at the first follow-up was significantly lower in ESD (11.1% vs 25.8%, P<0.05). The total number of resections until CRD was similar (1.3 vs. 1.8 times, P=0.14). CRD was achieved in 100% of ESD patients and 96.8% (214/221) of EMR patients (P=0.35). For patients who didn’t achieve CRD after EMR, 6/7 underwent esophagectomy and 1/7 entered palliative care. Local recurrence after CRD was significantly lower in ESD (1.9% [1/54] vs 12.5% [26/214], P<0.05). Local recurrence after ESD was successfully treated with endoscopy, while in the EMR group, 21/26 were successfully treated with endoscopy, 3/26 required esophagectomy, and 2/26 entered palliative care. The median total follow-up duration was significantly longer in EMR group [288 (130-524) days vs 623 (318-1171) days, P<0.05]. Conclusions Despite non-randomized treatment selection in which more advanced or concerning appearing lesions were selected for ESD, these patients showed significantly lower rates of persistent dysplasia at the initial follow-up. Furthermore, after achieving CRD, the ESD group demonstrated a reduced incidence of local recurrence. In contrast, some local recurrences after EMR necessitated esophagectomy, with some cases leading to palliative care. These findings suggest that ESD may provide a more favorable prognosis in the treatment of Barrett’s esophagus compared to EMR. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».