Downloaded from http://journals.lww.com/eurojgh by BhDMf5ePHKbH4TTImqenVIdHfOa5cT8d49u5HX8CIygZiBqi24+3gS31pQ1NAfYs on 06/05/2020 Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 0954-691X Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Original article DOI: 10.1097/MEG.0000000000001692 789 Endoscopic resection of early squamous neoplasia of the oesophagus: long-term follow-up in a UK population from a tertiary hospital Jen Yee Kuan a , Sameul Baskind b , Yeson Kim a , Stephen McGrath c , Ramakrishna Chaparala d , Arash Assadsangabi b , Neeraj Prasad b , George Regi e and Yeng Ang b,f Introduction Endoscopic resection is a minimally invasive technique that has been steadily gaining acceptance worldwide as a promising treatment for early-stage oesophageal squamous cell carcinoma (OSCC) [1–6]. Endoscopic resection can be classifed into piecemeal [endoscopic piecemeal mucosal resection (EpMR)] and en-bloc resections. En-bloc resec- tions can be further subdivided into endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and hybrid ESD. According to the European Society of Gastrointestinal Endoscopy (ESGE) guideline, the main criterion for endoscopic resection selection is the size of the tumour [7]. Additionally, it is recommended to be the primary treatment option for patients who are deemed to have increased risk for surgery [8]. The management of early-stage OSCC is highly dependent on two factors: the risk of lymph node metastases (>10% when lesion involves deeper than T1M2) versus the signifcant risks of morbidity and mortality associated with oesophagectomy [1,3,7–9]. Endoscopic resection shows a similar oncologic success rate as oesophagectomy with the additional bene- fts of being less invasive, less costly and has shorter oper- ation times and hospital stays [2,6,9,10,11]. Endoscopic resection has the potential to be a better treatment for early-stage OSCC due to its safety profle and comparable curative outcomes to surgery [9]. Endoscopic resection has been reported to be superior to endoscopic ultrasound (EUS) and endoscopic biopsy at detecting the presence of submucosal invasion and the metastatic potential of oesophageal squamous neoplasia [7,12,13]. Previous studies have reported that endoscopic resection specimens changed the diagnostic grade in 20–40% of lesions [7,13–15]. This can help guide subse- quent management decisions and therapeutic strategies by avoiding under or over treatment [13,14]. Research evidence for the effcacy of endoscopic resec- tion is predominantly sourced from Japan where it is well established for the treatment of early-stage OSCC [7]. However, the epidemiology of oesophageal cancer in Japan is different from the UK, and the undertaking of robust endoscopic resection studies is lacking in the West European Journal of Gastroenterology & Hepatology 2020, 32:789–796 Keywords: early oesophageal cancer, endoscopic mucosal resection, endoscopic resection, endoscopic submucosal dissection, oesophageal squamous cell carcinoma Departments of a Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK, b Gastroenterology, c Pathology, d Upper GI Surgery, Salford Royal NHS Foundation Trust, Salford, e Department of Gastroenterology, Acute Pennine NHS Foundation Trust, Rochdale Infirmary, Rochdale and f GI Science, DEG Division, FBMH, University of Manchester, Manchester, UK Correspondence to Yeng Ang, MD, Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, and GI Science, DEG Division, FBMH, University of Manchester, Manchester, UK Tel: +44 0161 2065794; e-mail: yeng.ang@srft.nhs.uk Received 10 September 2019 Accepted 3 January 2020 Aim To review the efficacy and outcomes of endoscopic resection in the diagnosis and treatment of oesophageal squamous dysplasia and early neoplasia. Methods This was a retrospective study between May 2012–2018. Twenty-one patients were treated with or considered for treatment with endoscopic resection at a tertiary hospital in the UK. The primary outcome was curative resection, defined as histologically proven complete resection of the lesion with deep/vertical margin ≥1 mm from neoplasia. Secondary outcomes were changes in staging from endoscopic resection histology, whether there was a complete reversal of dysplasia at 12-months or the latest endoscopic follow-up and 5-year overall survival rate. Results Seventeen patients (mean age = 66.5 years) with 20 lesions (35% en-bloc; 65% piecemeal resections) had endoscopic resection performed. Complete resection was achieved in 90% of lesions by endoscopic criteria, but this was confirmed in fewer lesions histologically. Curative resection was achieved histologically in 60% of lesions (11 patients) and noncurative resection in 40% of lesions (6 patients). Changes in staging from endoscopic resection histology were found in 79.2% of lesions (41.7% upstaged; 37.5% downstaged). No patients were found to have recurrence at their 12-month endoscopic follow-up. Eight of the 11 patients (72.7%) with curative resection remained clear of dysplasia/neoplasia throughout their follow-up (mean, 24.3 months; median, 19 months). The five-year overall survival rate was 64%. Conclusion In UK, endoscopic resection is useful in the management of early squamous neoplasia both for staging and (by piecemeal endoscopic resection in elderly unfit) for medium- to long-term disease clearance. Eur J Gastroenterol Hepatol 32: 789–796 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.