ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-19A

19A_Draganov EMR vs ESD for Barrett's

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The document is a presentation by Dr. Peter Draganov, a professor at the University of Florida, discussing Barrett's Esophagus and comparing two endoscopic techniques: Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). Dr. Draganov discloses multiple conflicts of interest, consulting for several medical companies.<br /><br />Dr. Draganov critiques traditional treatment strategies for dysplastic/neoplastic Barrett's Esophagus, particularly combining EMR with Radiofrequency Ablation (RFA). This approach is criticized due to a high recurrence rate and challenges with complete en-bloc resection, which complicates comprehensive evaluation of lateral and deep margins. These issues may hinder curative outcomes if cancer is present.<br /><br />He contrasts EMR’s benefits, such as facilitating post-procedure histological diagnosis and staging. EMR is described as a well-established, relatively easy procedure backed by high-level evidence, although it may not always achieve complete resection. <br /><br />A comparative analysis between EMR and ESD reveals the recurrence of Barrett's Esophagus is not markedly different between the two techniques. However, clinical outcomes indicate that ESD has higher rates of en-bloc and R0 resections, signifying more complete resection of lesions compared to EMR. Nevertheless, ESD introduces a higher risk of perforation, a critical consideration as reflected in a randomized controlled trial cited in the document.<br /><br />The document states EMR traditionally dominated endoscopic resection but highlights the expanding role of ESD, alongside RFA and emerging ablation techniques such as Cryotherapy and Hybrid Argon Plasma Coagulation, in treating Barrett’s Esophagus. This evolution in treatment underscores the need to adapt current therapeutic algorithms for more effective management of Barrett's-related neoplasia.

Keywords

Barrett's Esophagus

Endoscopic Mucosal Resection

Endoscopic Submucosal Dissection

Radiofrequency Ablation

en-bloc resection

recurrence rate

histological diagnosis

clinical outcomes

perforation risk

treatment strategies