PWE-117 Staging emr is essential for the management of early oesophageal neoplasia as conventional biopsy is not accurate in predicting final histology

• Published in: Gut Vol. 66; no. Suppl 2; p. A185
• Main Authors: Mcguire, JL, Patel, M, Cargill, T, Ravindran, R, Bailey, A, Collantes, E, Braden, B
• Format: Journal Article
• Language: English
• Published: 01.07.2017
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2017-314472.362

IntroductionBarrett’s oesophagus – associated dysplasia and neoplasia in early stages can be treated endoscopically, but accurate assessment before intervention is challenging.This study aimed to investigate the diagnostic accuracy of pre-resection biopsies in patients who undergo endoscopic mucosal resection (EMR) for dysplasia or early adenocarcinoma in the oesophagus.MethodWe searched our prospectively maintained database of patients referred for endoscopic treatment of dysplasia and early neoplasia in the oesophagus and compared the initial histology at referral obtained by forceps biopsy to the final staging after EMR. All EMRs were performed using band ligation mucosectomy. All histological reports were agreed by two expert pathologists and classified as non-dysplastic, low or high grade dysplasia, intramucosal or submucosal cancer. Downgrading or upgrading was defined as reporting the EMR specimen in a less or more severe histological category than the initial biopsy.ResultsBetween April 2010 and December 2016, 182 patients (140 m/ 42 f) with early oesophageal cancer or dysplasia were referred for endoscopic treatment and underwent endoscopic resection in 354 EMR sessions.Initial referral biopsies were accurate in predicting the final EMR histology in 48.6% but were upgraded in 77 of 182 patients (42.0%) and downgraded in 17 (9.4%) patients.ConclusionOnly in about half of patients, the initial referral histology by forceps biopsy correctly predicts the final histological result while EMR results in upstaging in more than 40%. Before embarking ablative on treatment, endoscopic resection of all visible lesions is mandatory irrespective of the histology obtained by forceps biopsy.Disclosure of InterestNone Declared