EVALUATION OF ENDOSCOPIC MUCOSECTOMY IN CASES OF BARRETT’S ESOPHAGUS WITH DYSPLASIA OR CARCINOMA IN SITU

Background: Barrett’s esophagus (BE) is a premalignant condition in which the normal squamous epithelium is replaced by intestinal metaplasia of variable length. Barrett’s esophagus represents the most serious consequence of chronic gastroesophageal reflux disease (GERD), primarily because of its association with an increased incidence of esophageal adenocarcinoma).Objectives: Estimation of the prevalence of Barrett esophagus among patients of GERD.Patients and methods: This study was carried out on 1268 patients presented to outpatient clinic complaining of symptoms suggestive of GERD. Forty BE patients were selected in this study.Results: The percentage of BE was 5.9% among selected GERD patients. There was a statistically significant difference in relation to age, sex, BE length, obesity and smoking. EMR alters histological grade in 25 % of patients. Of the patients, 5 (12.5 % ) were downgraded(LGD). There was no statistically significant difference in age, BE length and size of lesion resected between different grades of dysplasia. There were no deaths due to progression of Barrett’s adenocarcinoma( the death of patients due to unrelated causes). EMR was associated with few complications: Bleeding occurred in 10% of our patients and one patient (2.5%) developed stenosis. Follow-up for a median 20 months was available in 94.2% of patients. One patient (2.5%) had a metachronous lesion after 25 months, successfully treated with another EMR.Conclusion: Further experience is needed to determine the place of total removal of Barrett’s mucosa by a more extensive EMR. More training and exposure is required for gastroenterologists to become conversant with this technique. EMR should be performed by competent endoscopists, able to cope with procedural complications. However, more data are needed on the long-term results. A multicenter randomized trial comparing EMR, RFA and esophagectomy is required to establish the optimal treatment modality for HGD or EAC within SSBE or LSBE. Further studies to assess the role of endoscopic mucosal resection using a ligating device is needed especially in patients with BE and esophageal varices (a considerable medical problem in our locality).