Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett’s high-grade dysplasia and early gastric cancer

ABSTRACT

Aim: due to surgery´s high mortality and morbidity, local therapeutictechniques are required for Barrett’s high-grade dysplasia(BHGD) and early gastric cancer (EGC). Various techniques areavailable for endoscopic mucosal resection (EMR) in the GI tract.The ‘’suck and cut’’ technique, which uses a transparent cap ormodified multiband variceal ligator, is usually the most practicedmethod. A multiband ligator (ML) allows sequential resection withoutthe need for submucosal injection and endoscope withdrawal.The objective of this study was to evaluate the efficacy and safetyof EMR with a ML device in the treatment of Barrett’s high-gradedysplasia and early gastric cancer.Patients and methods: prospective study. Eight consecutivepatients (4 men; median age, 62 years; range 38-89 years) withBHGD (4) or EGC (4) were treated. EMR was performed with amultiband ligator in order to create a pseudopolyp and then permitsnare polypectomy of flat mucosal lesions. The pseudopolypwas resected by using pure coagulating current. No submucosalsaline injection was administered before resection.Results: a total of 8 consecutive patients were treated withthe multiband ligator (ML) technique. Barrett’s esophagus (BE)one patient with long BE received 3 EMR sessions. Three patientspresented with short BE and received 1 EMR session each. Thehistology of the EMR specimens confirmed a moderately differentiatedadenocarcinoma with submucosal infiltration (1 patient) andBHGD (3 patients). Early gastric cancer (EGC) 3 patients hadEGC (type IIa) and 1 patient had high-grade dysplasia. EMR wasaccomplished in 1 session for each patient. The histology of EMRspecimens confirmed a mucinous adenocarcinoma with submucosalinfiltration (1 patient), EGC (2 patients), and HGD (1 patient).Complications (mild esophageal stenosis, minor bleeding)occurred in 2 patients...(AU)