Margin clearance and post‐procedure ablation decrease recurrence risk in endoscopic mucosal resections for Barrett's‐related neoplasia

Aims Endoscopic mucosal resection (EMR) is widely used for treating Barrett's‐related oesophageal dysplasia and low‐stage carcinoma. Disease can recur after this procedure. We analysed a large cohort of EMR specimens to assess clinical and histopathologic factors and their relationship to recurrence. Methods and results We conducted a retrospective study of 129 patients who had in total 290 oesophageal EMRs for glandular neoplasia. Patient age, patient sex, specimen fragmentation, intestinal metaplasia, highest‐grade lesion, margin status and clearance, cancer invasion depth, lymphovascular invasion, tumour budding (using published guidelines for colorectal carcinoma), post‐procedure cryoablation/radiofrequency ablation and disease recurrence were recorded. Statistical analyses were performed on 227 eligible cases to determine the significance of these factors in local disease recurrence. Adenocarcinoma was the highest‐grade lesion in 42% of the 290 specimens, high‐grade dysplasia in 36% and low‐grade dysplasia in 22%. Mean age at first EMR was 66 years. Among the 227 statistically analysed cases, post‐procedure ablation was performed for 111 (49%) and recurrence of same or worse disease was documented in 104 (46%). Tumour depth and budding did not affect recurrence risk. On multivariate analysis, lack of post‐procedure ablation was associated with increased recurrence risk for high‐grade dysplasia and carcinoma. Additionally, poor differentiation and margin status were associated with increased recurrence risk for specimens with carcinoma. These relationships mostly held true for recurrence of same/worse neoplasia or recurrence of any neoplasia. Conclusions Differentiation, margin status and post‐EMR ablation influence the risk of local disease recurrence for Barrett's‐related adenocarcinoma, while other factors such as tumour budding and lesional depth do not.