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

19B_Wang_Barretts Debate-Favor ESD

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The debate surrounding the treatment of Barrett’s Esophagus in 2024 highlights the advantages of endoscopic submucosal dissection (ESD) over endoscopic mucosal resection (EMR). Dr. Andrew Y. Wang, an expert in gastroenterology, supports ESD, emphasizing its benefits for patients with complex or high-risk Barrett's Esophagus lesions. Wang argues that many would personally opt for ESD over EMR for its higher precision and effectiveness.<br /><br />Key points favoring ESD include its superior ability to achieve complete (R0) resection and eradicate neoplasia compared to EMR, as reported by Rubenstein et al. (Gastroenterol 2024). While recurrence rates between ESD and EMR are similar initially, longer-term studies demonstrate a significantly lower neoplastic recurrence with ESD at 3 years. Specifically, a study by Fujiyoshi et al. shows a recurrence rate of 1.9% for ESD versus 13% for EMR.<br /><br />ESD is particularly recommended for larger lesions, adenocarcinomas, and cases with deeper submucosal invasion or unclear preprocedural histology. In contrast, the AGA guideline suggests EMR may suffice for T1a lesions, but ESD is more adept at handling T1b lesions where depth penetration is crucial but not easily discernible until after resection.<br /><br />Despite some challenges in accurately staging early esophageal cancers (T1a vs. T1b) as reported by Schenck et al., ESD offers a more reassuring prognosis even for esophageal adenocarcinoma at a 3-year follow-up due to its thoroughness. Expert endoscopists can reliably differentiate between cancer stages which influences treatment decisions.<br /><br />In summary, ESD provides a more comprehensive approach to treating Barrett’s Esophagus, especially for complex cases, and offers better long-term outcomes regarding recurrence and curative resection.

Keywords

Barrett's Esophagus

endoscopic submucosal dissection

endoscopic mucosal resection

Dr. Andrew Y. Wang

gastroenterology

neoplastic recurrence

adenocarcinomas

AGA guideline

esophageal cancer staging

curative resection