Effect of endoscopic submucosal dissection on histologic diagnosis in Barrett's esophagus visible neoplasia

Dennis Yang, William King, Hiroyuki Aihara, Michael S. Karasik, Saowanee Ngamruengphong, Abdul Aziz Aadam, Mohamed O. Othman, Neil Sharma, Ian S. Grimm, Alaa Rostom, B. Joseph Elmunzer, Salmaan A. Jawaid, Yaseen B. Perbtani, Brenda J. Hoffman, Ashwin S. Akki, Alexander Schlachterman, Roxana M. Coman, Andrew Y. Wang, Peter V. Draganov

Research output: Contribution to journalArticlepeer-review


Background and Aims: Data are limited on the role of endoscopic submucosal dissection (ESD) as a potential diagnostic and staging tool in Barrett's esophagus (BE) neoplasia. We aimed to evaluate the frequency and factors associated with change of histologic diagnosis by ESD compared with pre-ESD histology. Methods: This was a multicenter, prospective cohort study of patients who underwent ESD for BE visible neoplasia. A change in histologic diagnosis was defined as “upstaged” or “downstaged” if the ESD specimen had a higher or lower degree, respectively, of dysplasia or neoplasia when compared with pre-ESD specimens. Results: Two hundred five patients (median age, 69 years; 81% men) with BE visible neoplasia underwent ESD from 2016 to 2021. Baseline histology was obtained using forceps (n = 182) or EMR (n = 23). ESD changed the histologic diagnosis in 55.1% of cases (113/205), of which 68.1% were upstaged and 31.9% downstaged. The frequency of change in diagnosis after ESD was similar whether baseline histology was obtained using forceps (55.5%) or EMR (52.2%) (P = .83). In aggregate, 23.9% of cases (49/205) were upstaged to invasive cancer on ESD histopathology. On multivariate analysis, lesions in the distal esophagus and gastroesophageal junction (odds ratio, 2.1; 95 confidence interval, 1.1-3.9; P = .02) and prior radiofrequency ablation (odds ratio, 2.5; 95% confidence interval, 1.2-5.5; P = .02) were predictors of change in histologic diagnosis. Conclusions: ESD led to a change of diagnosis in more than half of patients with BE visible neoplasia. Selective ESD can serve as a potential diagnostic and staging tool, particularly in those with suspected invasive disease. (Clinical trial registration number: NCT02989818.)

Original languageEnglish (US)
Pages (from-to)626-633
Number of pages8
JournalGastrointestinal endoscopy
Issue number4
StatePublished - Apr 2022

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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