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Wiley InterScience | ||
  The American Journal of GastroenterologyVolume 102 Issue 11, Pages 2380 - 2386 Published Online: 19 Jul 2007 © 2008 American College of Gastroenterology/Blackwell Publishing Official publication of the American College of Gastroenterology
Abstract | References | Full Text: HTML, PDF (Size: 233K) | Related Articles | Citation Tracking  Significance of Neoplastic Involvement of Margins Obtained by Endoscopic Mucosal Resection in Barrett's Esophagus Copyright 2007 by Am. Coll. of Gastroenterology (Am J Gastroenterol 2007;102:2380–2386) ABSTRACTOBJECTIVES: Although EMR has been used for elimination of neoplasia in BE, the significance of positive carcinoma margins and depth of invasion on endoscopic resection pathology has not been assessed using a valid standard. The aim of this study was to assess the accuracy of tumor staging by EMR using esophagectomy as the standard. METHODS: Medical records of patients, who underwent endoscopic resection for esophageal carcinoma or high-grade dysplasia in BE followed by esophagectomy, were reviewed. Data were abstracted from a prospectively maintained EMR database. Endosonography and endoscopic resection were performed by a single experienced endoscopist. Two experienced GI pathologists interpreted all histological results. Standard statistical tests were used to compare continuous and categorical variables. RESULTS: Twenty-five patients were included in the study. Three patients had mucosal carcinoma and 16 had submucosal carcinoma following endoscopic resection. Surgical pathology staging was consistent with preoperative EMR staging in all patients. No patient with negative mucosal resection margins had residual tumor at the resection site at esophagectomy. In patients with submucosal carcinoma, 8 had residual carcinoma at the EMR site at surgery and 5 patients had metastatic lymphadenopathy. CONCLUSIONS: Tumor staging using EMR pathology is accurate when compared with surgical pathology following esophagectomy. Negative margins on EMR pathology correlate with absence of residual disease at the EMR site at esophagectomy. Submucosal carcinoma on EMR specimens was associated with a high prevalence of residual disease at surgery (50%) and metastatic lymphadenopathy (31%). Received June 18, 2006; accepted May 15, 2007. |  |
