Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett's neoplasia

• Published in: Gastrointestinal endoscopy Vol. 74; no. 1; pp. 35 - 43
• Main Authors: Pouw, Roos E., MD, van Vilsteren, Frederike G.I., MD, Peters, Femke P., MD, PhD, Herrero, Lorenza Alvarez, MD, ten Kate, Fiebo J.W., MD, PhD, Visser, Mike, MD, Schenk, Boudewijn E., MD, PhD, Schoon, Erik J., MD, PhD, Peters, Frans T.M., MD, PhD, Houben, Martin, MD, PhD, Bisschops, Raf, MD, PhD, Weusten, Bas L.A.M., MD, PhD, Bergman, Jacques J.G.H.M., MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.07.2011; Elsevier
• Subjects: Aged; Barrett Esophagus - surgery; Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Esophagoscopy - adverse effects; Esophagoscopy - methods; Esophagus; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Mucous Membrane - surgery; Other diseases. Semiology; Prospective Studies; BE; HGIN; ns; CI; IQR; interquartile range; RFA; ER; multiband mucosectomy; high-grade intraepithelial neoplasia; APC; Barrett's esophagus; argon plasma coagulation; not significant; MBM; confidence interval; radiofrequency ablation; endoscopic resection; Endoscopic surgery; Premalignant lesion; Treatment; Esophageal disease; Mucosectomy; Digestive diseases; Malignant tumor; Comparative study; Cancer
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.03.1243

Background Endoscopic resection (ER) is an important treatment for high-grade intraepithelial neoplasia and early cancer in Barrett's esophagus. ER-cap requires submucosal lifting and positioning of a snare in the cap, making it technically demanding and laborious. Multiband mucosectomy (MBM) uses a modified variceal band ligator and requires no submucosal lifting or positioning of a snare. Objective To compare ER-cap and MBM for piecemeal ER of early Barrett's neoplasia. Design Randomized, controlled trial. Setting Tertiary-care and community-care centers. Patients This study involved 84 patients (64 men; median age 70 years) undergoing piecemeal ER of Barrett's neoplasia. Intervention Piecemeal ER was performed by using ER-cap (n = 42) or MBM (n = 42). Main Outcome Measurements Safety, efficacy, procedure time, costs. Results Procedure time (34 vs 50 minutes; P = .02) and costs (€240 vs €322; P < .01) were significantly less with MBM compared with ER-cap. MBM resulted in smaller resection specimens than ER-cap (18 ×13 mm vs 20 × 15 mm; P < .01). Maximum thicknesses of specimens and resected submucosa were not significantly different. There were no clinically relevant bleeding episodes. Four perforations occurred, 3 with ER-cap, 1 with MBM ( P = not significant). Limitations Potential bias because of different levels of experience among participating endoscopists. Conclusion Piecemeal ER with MBM is faster and cheaper than with ER-cap. Despite the lack of submucosal lifting, MBM appears not to be associated with more perforations. Although MBM results in slightly smaller specimens, the clinical relevance of this may be limited because depth of resections does not differ between both techniques. MBM may thus be preferred for piecemeal ER of early Barrett's neoplasia. (Clinical trial registration number: NTR1435.)