Endoscopic Submucosal Dissection Use Changes Histologic Diagnosis in More Than Half of All Patients With Visible Barrett’s Esophagus Neoplasia

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have emerged as important treatment techniques for patients with visible lesions in Barrett’s esophagus (BE). Whereas EMR has been shown to change the diagnosis in patients with BE (compared to biopsy results), similar data for ESD are not known. 

This prospective multicenter cohort study included 205 patients (median age, 69 years; 166 males) who received ESD for visible BE lesions. The baseline histology was determined by forceps biopsy (n=182) or EMR (n=23) and compared with the histologic diagnosis from the ESD specimen. Most lesions (n=142; 69.3%) were in the distal esophagus and/or the gastroesophageal junction versus 63 (30.7%) in the body of the esophagus. All lesions were removed en bloc, and R0 resection was achieved in all patients. 

Overall, ESD resulted in a change in diagnosis from the initial biopsy or EMR in 55.1% of the patients (n=113). Of the diagnosis changes, 68.1% were upstaged and 31.9% downstaged from the initial histopathologic diagnosis. Upstaging to invasive cancer from intramucosal cancer (IMC) occurred in 28 patients (28/77; 36.4%), from high-grade dysplasia (HGD) to IMC in 22 patients (22/77; 28.6%), and from HGD to invasive cancer in 12 patients (12/77; 15.6%). The most frequent downstaged results were IMC to HGD (13/36; 36.1%), invasive cancer to IMC (9/36; 25%), and HGD to low-grade dysplasia (4/36; 11.1%). In total, 23.9% (49/205) of patients were upstaged to invasive cancer and 6.3% (13/205) were downgraded from invasive cancer to a lesser histopathologic diagnosis.