COMPARISON OF ESD AND SUPERFICIAL FORCEPS BIOPSY PATHOLOGY FOR ESOPHAGEAL LESIONS

ABSTRACT

DDW 2022 Author Disclosures Daniel Scanlon NO financial relationship with a commercial interest ;Brianna Shinn NO financial relationship with a commercial interest ;Zachary Lieb NO financial relationship with a commercial interest ;Brian Jacobs NO financial relationship with a commercial interest ;Divya Chalikonda NO financial relationship with a commercial interest ;Jason Ho NO financial relationship with a commercial interest ;Abhishek Agnihotri NO financial relationship with a commercial interest ;Anand Kumar YES financial relationship with a commercial interest;OlympusConsulting ;Anthony Infantolino NO financial relationship with a commercial interest ;Christina Tofani NO financial relationship with a commercial interest ;Alexander Schlachterman NO financial relationship with a commercial interest Introduction: Endoscopic submucosal dissection (ESD) is a minimally invasive technique used for removal of superficial dysplastic or early cancerous esophageal lesions. Many of these lesions arise in a background of Barrett’s esophagus (BE) which is a known precursor of dysplasia and adenocarcinoma. Large lesions not amenable to endoscopic mucosal resection often have superficial forceps biopsies taken prior to referral for ESD. This study aims to evaluate the accuracy of superficial forceps biopsies compared with pathology from ESD. Methods: A retrospective medical record review was performed that included consecutive patients who underwent ESD for esophageal lesions at a tertiary care center between 6/2018 and 9/2021. Pathology results from outside hospital and same institution superficial forceps biopsies as well as ESD pathology reports were reviewed. The primary outcome measured was the number of patients found to have higher disease severity on ESD pathology compared with pre-ESD superficial forceps biopsies. Results: The 28 patients included in the study received superficial forceps biopsies at outside hospitals (n=9), the same institution (n=14), or both (n=5). An average of 99 days occurred between outside hospital superficial forceps biopsies and ESD compared with an average of 30 days between superficial forceps biopsies and ESD performed at the same institution. Delays between superficial forceps biopsies and ESD may be related to the COVID-19 pandemic leading to prolonged time between procedures. In the entire cohort, ESD pathology differed from superficial forceps biopsies in 13/28 patients (46%). 10 patients (36%) had their disease severity upgraded and 3 were newly diagnosed with cancer on ESD pathology. Findings were similar for patients with lesions arising in a background of BE (21/28) (Table 1). Of those with BE, 9/21 (43%) patients had ESD pathology that differed from superficial forceps biopsies with 6 patients (29%) receiving increased disease severity and 2 patients receiving a new cancer diagnosis on ESD pathology. Conclusion: Superficial forceps biopsies taken prior to resection of esophageal lesions via ESD were concordant with ESD pathology in the majority of cases, however 36% of patients received upgraded disease severity on ESD pathology. Findings were similar for patients with or without a background of Barrett’s esophagus. These results highlight the importance of en bloc resection not only for therapeutic benefit (60% of patients in this cohort achieved R0 resection), but for accurate staging of esophageal lesions. [Formula presented]