daw
07-10-2003, 09:58 PM
Circumferential EMR and complete removal of Barrett's
epithelium: A new approach to management of Barrett's
esophagus containing high-grade intraepithelial neoplasia
and intramucosal carcinoma.
Gastrointest Endosc 2003
Jun;57(7):854-9 Seewald S; Akaraviputh T; Seitz U; Brand B;
Groth S; Mendoza G; He X; Thonke F; Stolte M; Schroeder S;
Soehendra N
BACKGROUND: There is no study of circumferential EMR in
patients with Barrett's esophagus containing early stage
malignant lesions. This study investigated the
effectiveness and safety of circumferential EMR by using a
simple snare technique without cap.
METHOD: Patients with Barrett's esophagus containing
multifocal high-grade intraepithelial neoplasia or
intramucosal cancer, and patients with endoscopically
nonidentifiable early stage malignant mucosal changes
incidentally detected in random biopsy specimens were
included in the study. A 30 x 50-mm polypectomy snare made
of monofilament 0.4-mm steel wire was used without any
additional device or submucosal injection.
RESULTS: Twelve patients (10 men, 2 women; median age 63.5
years, range 43-88 years) underwent circumferential EMR; 5
had multifocal lesions, and 7 had no visible lesions.
Segments of Barrett's epithelium were circumferential
(median length 5 cm) and completely removed. The median
number of EMR sessions was 2.5. The median number of snare
resections per EMR session was 5. The medial total area of
mucosa in resected specimens per session was 3.8 cm(2). Two
patients developed strictures that were successfully
treated by bougienage. Minor bleeding occurred during 4 of
31 EMR sessions. During a median follow-up of 9 months, no
recurrence of Barrett's esophagus or malignancy was
observed.
CONCLUSIONS:
Circumferential EMR with a simple snare technique is
feasible, safe, and effective for complete removal of
Barrett's epithelium with early stage malignant changes.
http://www.medscape.com/viewarticle/457889_print?WebLogicSession=Pw4I7XoIgyWWUfPYo7l6f RsfxNmbLLcATbDpUrBlUXVDtz7aL98O|255872370386031038 6/184161393/6/7001/7001/7002/7002/7001/-1
epithelium: A new approach to management of Barrett's
esophagus containing high-grade intraepithelial neoplasia
and intramucosal carcinoma.
Gastrointest Endosc 2003
Jun;57(7):854-9 Seewald S; Akaraviputh T; Seitz U; Brand B;
Groth S; Mendoza G; He X; Thonke F; Stolte M; Schroeder S;
Soehendra N
BACKGROUND: There is no study of circumferential EMR in
patients with Barrett's esophagus containing early stage
malignant lesions. This study investigated the
effectiveness and safety of circumferential EMR by using a
simple snare technique without cap.
METHOD: Patients with Barrett's esophagus containing
multifocal high-grade intraepithelial neoplasia or
intramucosal cancer, and patients with endoscopically
nonidentifiable early stage malignant mucosal changes
incidentally detected in random biopsy specimens were
included in the study. A 30 x 50-mm polypectomy snare made
of monofilament 0.4-mm steel wire was used without any
additional device or submucosal injection.
RESULTS: Twelve patients (10 men, 2 women; median age 63.5
years, range 43-88 years) underwent circumferential EMR; 5
had multifocal lesions, and 7 had no visible lesions.
Segments of Barrett's epithelium were circumferential
(median length 5 cm) and completely removed. The median
number of EMR sessions was 2.5. The median number of snare
resections per EMR session was 5. The medial total area of
mucosa in resected specimens per session was 3.8 cm(2). Two
patients developed strictures that were successfully
treated by bougienage. Minor bleeding occurred during 4 of
31 EMR sessions. During a median follow-up of 9 months, no
recurrence of Barrett's esophagus or malignancy was
observed.
CONCLUSIONS:
Circumferential EMR with a simple snare technique is
feasible, safe, and effective for complete removal of
Barrett's epithelium with early stage malignant changes.
http://www.medscape.com/viewarticle/457889_print?WebLogicSession=Pw4I7XoIgyWWUfPYo7l6f RsfxNmbLLcATbDpUrBlUXVDtz7aL98O|255872370386031038 6/184161393/6/7001/7001/7002/7002/7001/-1