Safety and efficacy of salvage endoscopic submucosal dissection for Barrett’s neoplasia recurrence after radiofrequency ablation

Aims We aimed to review the safety and efficacy of salvage ESD for Barrett’s neoplasia recurrence after radiofrequency ablation (RFA). Methods We conducted a multicentric retrospective study, collecting data from patients in six Belgian, eight European and one Australian centers. We included all patients who achieved at least one RFA treatment for BE and had further esophageal ESD for neoplasia recurrence. Results From April 2014 until June 2022, data from 56 salvage ESD procedures were collected. Histological analysis showed 37 adenocarcinoma, 17 HGD and 2 LGD. En-bloc resection was achieved in 89% and R0 resection was obtained in 76% of ESD with HGD and in 49% of ESD with carcinoma. 39 patients (57%) had a curative resection, 29 (41%) were non-curative with 21% of local risk resection and 20% of high risk resection [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ]. Immediate complications comprised 2 transmural perforations (4%) treated with stent or clip during the endoscopy. Seven patients (12%) had strictures, treated by dilatation. At the end of follow-up after salvage ESD eventually associated to further endoscopic treatment, neoplasia remission was obtained in 82% of the patient (97% if salvage ESD specimen was curative, 75% if local risk and 55% if high risk). The median incidence of salvage ESD was 0.9 per 100 ESD for BE and 0.6 per 100 patients treated with RFA per center. Conclusions This multicenter retrospective study confirms that ESD performed by expert endoscopists is an efficient and safe treatment for recurrence of neoplasia after RFA treatment for Barrett’s esophagus and might therefore be proposed for selected cases after RFA in expert centers, with close endoscopic surveillance of the patients. Follow-up after salvage ESD ([ Fig. 1 ]). Fig. 1 Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany