The Superiority of Endoscopic Submucosal Dissection to Endoscopic Mucosal Resection for Achieving Negative Margins in Adenocarcinomas of the Gastroesophageal Junction: A Histopathological Evaluation
Received Date: Aug 04, 2016 / Accepted Date: Aug 17, 2016 / Published Date: Aug 19, 2016
Background: Due to the significant morbidity associated with esophagectomy, advanced endoscopic therapies have been developed for diagnosis and resection of gastroesophageal junctional (GEJ) adenocarcinomas.
Methods: A retrospective review of all adenocarcinomas at the GEJ removed via EMR or ESD over a ten-year period with coexisting BE (2004-2014) was performed. Thirty-one cases met the study inclusion criteria. All cases were re-reviewed by a gastrointestinal pathologist, and a chi-square analysis of all variables including tumor stage, degree of differentiation, depth of invasion, presence of lymphovascular invasion, and margin status was performed to evaluate for statistically significant differences between EMR and ESD.
Results: ESDs were significantly more likely than EMRs to yield negative margins (64.3% vs. 35.7%; pvalue= 0.026). ESDs also produced fewer positive deep margins than EMRs; however, when the deep margin was analyzed independently, this number did not quite reach statistical significance (30.8% vs. 69.2%; p-value=0.057)
Conclusion: This study demonstrates that ESD is superior to EMR for achieving negative margins in endoscopically resected adenocarcinomas at the GEJ. ESD also allows for better margin assessment histologically by the pathologist. Further, we believe that as the number of ESDs performed increases, we will also see that ESD will be more likely to provide both deep and lateral margin negativity.
Keywords: Barrett’s esophagus; Esophageal adenocarcinoma; Endoscopic submucosal dissection; Endoscopic mucosal resection; Gastroesophageal junction
Citation: Martelli MG, Gonzalo DH, Chang MD, Xiaomin Lu, Draganov PV, et al. (2016) The Superiority of Endoscopic Submucosal Dissection to Endoscopic Mucosal Resection for Achieving Negative Margins in Adenocarcinomas of the Gastroesophageal Junction: A Histopathological Evaluation. J Clin Exp Pathol 6:290. Doi: 10.4172/2161-0681.1000290
Copyright: © 2016 Martelli MG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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