# Journey to complete remission of dysplasia and intestinal metaplasia after ESD and EMR of Barrett’s esophagus-related neoplasia

## TL;DR

This study compares the effectiveness of ESD and cEMR in treating Barrett’s esophagus-related neoplasia and finds similar outcomes in achieving remission despite initial differences in resection rates.

## Contribution

The study provides a comparative analysis of ESD and cEMR in the journey to remission of dysplasia and intestinal metaplasia in Barrett’s esophagus.

## Key findings

- ESD had higher en-bloc resection rates compared to cEMR.
- Initial ESD was associated with higher complete remission of dysplasia rates.
- Over time, both groups showed comparable rates of achieving remission.

## Abstract

Although endoscopic submucosal dissection (ESD) is associated with higher en-bloc and R0 resection rates than cap-assisted endoscopic mucosal resection (cEMR), its comparative impact on achieving complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) in BE endoscopic eradication therapy (EET) is not well defined. We aimed to compare the journey of patients from initial endoscopic resection (ER) with ESD and cEMR to achieving CRD and CRIM.

Patients undergoing ESD or cEMR followed by ablation for BE neoplasia at two academic institutions in the United States were included. Primary outcomes included CRD and CRIM rates following ER in the two groups. Secondary outcomes included the number of resection/ablative procedures from initial ER to achieving CRD and CRIM. Inverse probability treatment weighting (IPTW) was used to balance confounding variables between groups.

A total of 801 patients (606 cEMR, 195 ESD) were included. ESD group patients had higher en-bloc resection rates (ESD 94.4%, cEMR 44.7%). Higher rates of CRD were observed in patients undergoing initial ESD (HR 1.53,
P
< 0.01). With time-to-event and IPTW analyses, rates of achieving CRD and CRIM were comparable between the groups. There were no significant differences in mean number of endoscopic resection or ablative procedures among patients undergoing initial cEMR resection compared with those treated with initial ESD.

Despite larger lesion sizes and more cancers in patients undergoing ESD, the EET journey to achieving CRD and CRIM was comparable to that in patients receiving cEMR. Prospective studies are required to further study differences between these two treatment approaches.