Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Barrett's Neoplasia: Clinical Outcomes at a Canadian Tertiary Referral Center
Bibliographic record
Abstract
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
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".