Sa1547The Efficacy of Cryospray Ablation Therapy in EradicatingDysplastic Barrett’s EsophagusJayaprakash Sreenarasimhaiah, Deepak Agrawal, Luis F. LaraMedicine/Gastroenterology, University of Texas Southwestern MedicalCenter, Dallas, TXBackground: Dysplastic Barrett’s esophagus has historically been treated bysurgery. However, endoscopic therapy has recently become well-established as aminimally-invasive alternative. One of the newest modalities available iscryospray ablation therapy. Aims: To determine if cryospray ablation therapy is asafe and effective means for ablation of dysplastic Barrett’s esophagus. Methods:All consecutive patients who underwent cryospray ablation therapy for dysplasticBarrett’s esophagus over a 24-month period were included. Patients were treatedwith liquid nitrogen (CSA Medical) for high-grade dysplasia (HGD) or persistentlow-grade dysplasia (LGD, noted on two endoscopies at 6-month intervals).Nodules were treated with a combination of endoscopic mucosal resection(EMR) and cryospray ablation therapy. Endoscopic ultrasound was used toconfirm that disease was confined to the esophageal mucosa in high-gradedysplastic or nodular carcinoma cases. Results: The study group included 26patients (mean age 67.1 years; 19 male and 7 female) who underwent a total of57 sessions of cryospray ablation therapy. The mean number of sessions was 2.2per patient with a mean length of 5.7cm. HGD was seen in 14 patients;intramucosal cancer was noted in 3 patients; persistent LGD was present in 9patients. Three patients were lost to follow-up due to insurance or co-morbidillness. Of 23 patients who completed therapy, 20 (87%) had no visible Barrett’smucosa. In 3 /23 (13%), histologic features of Barrett’s mucosa was notedwithout dysplasia. In all 3 patients with intramucosal nodular carcinoma,endoscopic therapy was successful with no findings at 6 months - cryosprayalone (1), EMR prior to cryotherapy (1), and EMR following cryotherapy (1). Nopatients required narcotics or hospitalization following the procedure. In 57sessions of cryotherapy, 3 (5%) strictures developed which were treatedsuccessfully with endoscopic balloon dilation. Conclusions: Cryospray ablationtherapy is effective in the complete eradication of Barrett’s with high-gradedysplasia, low-grade dysplasia, and intramucosal (T1) carcinoma. This therapycan be successfully combined with EMR therapy. The low stricture rate and lackof significant post-procedure pain demonstrate the safety and attractiveness ofthis modality.

Sa1548Temporary Self-Expanding Plastic Stent Placement orBiodegradable Stent Placement for Refractory BenignEsophageal Strictures: A ComparisonPetra G. Van Boeckel, Frank P. Vleggaar, Peter D. SiersemaGastroenterology and Hepatology, University Medical Center Utrecht,Utrecht, NetherlandsBackground: Benign esophageal strictures refractory to standard dilation therapyare a challenging problem. Temporary self-expanding plastic stent (SEPS)placement is increasingly being used in an effort to prolong the dilation effect inpatients with refractory benign esophageal strictures (RBES). Recently,biodegradable (BD) stents have been introduced as an alternative stent designfor treatment of RBES. Aim: To determine clinical effectiveness and safety ofSEPS or BD stent placement for the treatment of RBES. Methods: Two groups ofconsecutive patients with RBES who underwent temporary SEPS placement for aperiod of 6 weeks or BD stent placement were included. Data were collectedwith respect to technical and clinical success, complications, recurrent dysphagiaand number of reinterventions. Results: In total, 38 patients with dysphagia fromRBES were treated with placement of a SEPS (n�20) or BD stent (n�18). Theetiology of the strictures was peptic (SEPS 1, BD stent 6), anastomotic (SEPS 8,BD stent 5), post-radiation (SEPS 5, BD stent 2), post-caustic (SEPS 4, BD stent 2)or another cause (SEPS 2, BD stent 3) (p�0.18). Stent placement was technicallysuccessful in 19 (95%) patients with a SEPS, and in 16 (89%) with a BD stent(p� 0.49). SEPS removal was performed in 16/19 (84%) patients with successfulSEPS placement. Six of 20 (30%) patients with SEPS were dysphagia-free after amedian follow-up of 385 days (range 77-924), 10 (50%) developed recurrentdysphagia and in 3 (15%) the SEPS was not removed. Six (33%) of 18 patientswith a BD stent were dysphagia-free after a median follow-up of 166 days (range21-559) (p�0.83 compared to SEPS) and 12 (67%) had recurrent dysphagia.Major complications occurred in 2 (10%) patients with a SEPS (hemorrhage [n�1]and perforation [n�1]) and in 4 (22%) with a BD stent (hemorrhage [n�2],severe retrosternal pain [n�2]) (p�0.30). Reinterventions were less frequentlyperformed after BD stent placement than after SEPS placement (15 (mean: 0.8�/- 0.6 per stent placed) vs. 21 (mean: 1.3 �/- 0.4 per stent placed),respectively, p�0.03). There was no stent-related mortality. Conclusion: BothSEPS and BD stent placement achieve long-term relief of dysphagia withoutfurther interventions in a third of patients with RBES. BD stents have theadvantage over SEPS that fewer procedures are required. Although stentplacement is an interesting treatment option in patients with RBES, the idealstrategy still needs to be defined.

Sa1549Endoscopic Ultrasonography in Preoperative Staging of Cancerin Esophagus and Cardia and the Impact of NeoadjuvantTherapy on Its ReliabilityLudek Hrdlicka1, Radan Keil1, Tomas Harustiak2,Markéta Roznetinská1

1Department of Internal Medicine, Faculty Hospital Motol, Praha 5,Czech Republic; 23-rd Surgical Department, Faculty Hospital Motol,Prague 5, Czech RepublicIntroduction: Endoscopic ultrasonography (EUS) is generally accepted as themost contributable method in local staging of esophageal cancer. It has agreatest impact on indication of primary surgical therapy or neoadjuvant therapyin potentially resectable processes. After neoadjuvant therapy is usually anendosonographic restaging performed. Because of structural tissue changes afterradio and chemotherapy resulting in worse conditions for ultrasonography theaccuracy of EUS can be decreased, that is why we designed comparative studywith surgical finding and histopathology as a gold standard. Methods: Wefollowed prospectively preoperative examinations of patients with histologicallyconfirmed cancer in esophagus or cardia in whom a staging with EUS wasperformed (Olympus MH-908 a JF-UM20) in our department during the year2009. Results were compared with surgical findings and definite TNMclassification. In patients treated with neoadjuvant therapy restaging wasperformed after the end of treatment. Then we compared EUS results of patientswith and without neoadjuvant therapy. In 2009 we examined in our department96 patients with the above diagnosis. In our sample we included 49 patients inwhom we performed a complete preoperative staging and underwent radicalsurgery with possibility of definitive histopathological classification of TN stage.Results: From 49 patients in our sample 39 patients had adenocarcinoma and 10spinocellular carcinoma. Stage T1 was preoperatively determined in 6 patients (4treated with endoscopic resection and 2 treated surgically), stage T2 in 11patients, T3 in 27 patients an T4 in 5 patients of our sample. 33 patientsunderwent neoadjuvant therapy and subsequent restaging Sensitivity andspecificity in preoperative EUS were in stage T1 100%, in stage T2 sensitivity was77% and specificity 90%, in T3 sensitivity 86% and specificity 75%, in stage T4sensitivity 80% and specificity 75%. Comparison of sensitivity and specificity in Tstaging in patients without neoadjuvant therapy (16 patients) and afterneoadjuvant radio-chemotherapy (33 patients) is 88% vs. 81% and 95% vs. 75%.Sensitivity for regional mediastinal lymph nodes was 65%, specificity 75%, forceliac lymph nodes 60% sensitivity and 95% specificity. Conclusion: In our studypreoperative EUS staging was compared with surgical finding and definitivehistopathological classification of TN stage. Radial EUS provided useful andcomparatively reliable information about local stage of the disease in decisionabout the treatment options in patients with cancer in oesophagus or cardia. Wefound high sensitivity and specificity in T staging, the yield in N staging waslower. Neoadjuvant radio-chemotherapy significantly decreased reliability of EUST staging in preoperative restaging of cancer in oesophagus and cardia.

Sa1550Lower Recurrence Rate With ESD vs. EMR for the CurativeTreatment of Esophageal Superficial Squamous Cell CarcinomaPierre H. Deprez1, Romain Altwegg1, Anne Jouret- Mourin2,Christine Sempoux2, Tarik Aouattah1, Ralph C. Yeung1,Hubert Piessevaux1

1Gastroenterology, Cliniques universitaires Saint-Luc, Brussels, Belgium;2Pathology, Cliniques universitaires Saint-Luc, Brussels, BelgiumIntroduction: The role of endoscopic submucosal dissection (ESD) in squamouscell carcinoma is still discussed in Europe with many centres proposingpiecemeal EMR, although many studies from Japan showed the importance of R0that can only be achieved by en-bloc resection with free deep and lateralmargins. The aim of our study was to analyse our experience with ESD and tocompare these with historical results of piecemeal EMR. Patients and Methods:EMR and ESD have been performed for superficial squamous cell cancer sinceDec 1999 and Jan 2007, respectively. Follow-up was done at 2, 6, 12 monthsafter resection, then annually. Results: are expressed as median and range andstatistical analysis done by Mann Whitney U-test and chi square. Results: 60patients (30 pts by EMR since Dec 1999 and 30 pts by ESD since Jan 2007). Nosignificant difference could be seen in terms of age, sex, Paris classification,tumor localisation, and R0 resection (Table 1). Complications rate was similar: noperforation, no early or delayed bleeding, 17-20% strictures, with 4 pts withsevere fibrosis (type 3) due to previous EMR, eosinophilic esophagitis,radiotherapy or surgery. In the ESD group, 6 lesions were HGIN, 3 pT1m2, 11pT1m3, 8 pT1sm1, and 2 pT1sm2. In the EMR group, 16 lesions were HGIN, 4pT1m2, 5 pT1m3, 3 pT1sm1, 1 pT1sm2 and 1 T2. Recurrence rate wassignificantly lower with ESD (1 case [3%] vs. 8 [26%] with EMR, p � 0,01), andrecurrence was observed after a median follow-up period of 11,5 m [3-53]. Eightpts and 7 received adjuvant therapy in the ESD and EMR groups, respectively.Conclusions: ESD can be safely performed for the curative treatment of mucosalesophageal squamous cancer, with low rates of bleeding and perforation, higher

Abstracts

AB204 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011 www.giejournal.org