Endoscopic submucosal dissection for the treatment of early Barrett’s neoplasia: long-term outcomes of a prospective multicenter study

Guillaume Bergez; Vincent Lepilliez; Thierry Ponchon; Mathieu Pioche; Jérome Rivory; Timothée Wallenhorst; Emmanuel Coron; Nicolas Chapelle; Jérémie Jacques; Romain Legros; Pierre Deprez; Enrique Perez Cuadrado Robles; Arthur Berger; Edouard Chabrun; Geoffroy Vanbiervliet; Stanislas Chaussade; Sarah Leblanc; Romain Coriat; Frédéric Prat; Maximilien Barret

Authors Guillaume Bergez, Vincent Lepilliez, Thierry Ponchon, Mathieu Pioche, Jérome Rivory, Timothée Wallenhorst, Emmanuel Coron, Nicolas Chapelle, Jérémie Jacques, Romain Legros, Pierre Deprez, Enrique Perez Cuadrado Robles, Arthur Berger, Edouard Chabrun, Geoffroy Vanbiervliet, Stanislas Chaussade, Sarah Leblanc, Romain Coriat, Frédéric Prat, Maximilien Barret.

Abstract

Background Endoscopic submucosal dissection (ESD) allows for en bloc endoscopic resection of T1 esophageal adenocarcinoma arising on Barrett’s esophagus (BE). Although the safety of the procedure is well established, the oncological adequacy of the procedure and the long-term follow up of the patients have not been prospectively studied.

Methods We conducted a prospective, multicenter study involving 9 French and Belgian centers. We included patients treated with ESD for a visible endoscopic lesion of more than 15mm documented with dysplasia, with a 3-year follow up. The primary endpoint was the histologically complete resection rate for adenocarcinoma and high-grade dysplasia (HGD).

Results A total of 141 patients were included in the study between December 2016 and January 2019. The R0 resection rate was 85% for adenocarcinoma and HGD, and 81% for invasive adenocarcinoma. The complication rate was 17%, of which 5% were early complications and 12% were late complications, mainly esophageal strictures. During a median follow-up length of 36.3 months, recurrence was observed in 15% of the patients and was endoscopically manageable in 44%. Eight patients (6%) underwent esophagectomy for a high-risk adenocarcinoma. Overall, 14 patients (12%) died during follow up, 3 of them (2.5%) from esophageal adenocarcinoma.

Conclusion Endoscopic resection by ESD is a safe and effective technique to treat T1 esophageal adenocarcinoma, allowing avoidance of esophagectomy in 94% of the patients.

Keywords Barrett’s esophagus, esophageal adenocarcinoma, early esophageal neoplasia, endoscopic submucosal dissection

Ann Gastroenterol 2026; 39 (5): 597-604