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Belghazi K, Marcon N, Teshima C, Wang KK, Milano RV, Mostafavi N, Wallace MB, Kandel P, Mejía Pérez LK, Bourke MJ, Bahin F, Everson MA, Haidry R, Ginsberg GG, Ma GK, Koch AD, Ragunath K, Ortiz-Fernandez-Sordo J, di Pietro M, Seewald S, Weusten BL, Schoon EJ, Bisschops R, Bergman JJ, Pouw RE. Risk factors for serious adverse events associated with multiband mucosectomy in Barrett's esophagus: an international multicenter analysis of 3827 endoscopic resection procedures. Gastrointest Endosc 2020; 92:259-268.e2. [PMID: 32240684 DOI: 10.1016/j.gie.2020.03.3842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Multiband mucosectomy (MBM) is a widely used technique for the treatment of Barrett's esophagus (BE). However, large multicenter studies enabling a generalizable estimation of the risk of serious adverse events, such as perforation and postprocedural bleeding, are lacking. The aim of this study was to estimate the rate of, and risk factors for, serious adverse events associated with MBM. METHODS In this retrospective analysis, consecutive patients who underwent MBM for treatment of BE in 14 tertiary referral centers in Europe, the United States, Canada, and Australia were included. Primary outcomes were perforation and postprocedural bleeding rate. Potential risk factors were identified by logistic regression. RESULTS Between 2001 and 2016, a total of 3827 MBM procedures were performed in 2447 patients (84% male, mean age 66 years, median BE length C2M4). Perforation occurred in 17 procedures (0.4%; 95% confidence interval [CI], 0.3-0.7), of which 15 could be treated endoscopically or conservatively. Female gender was an independent risk factor for perforation (odds ratio [OR], 2.77; 95% CI, 1.02-7.57; P = .05). Postprocedural bleeding occurred after 35 procedures (0.9%; 95% CI, 0.6-1.3). The number of resections (OR, 1.15; 95% CI, 1.06-1.25; P < .001) was significantly associated with postprocedural bleeding. CONCLUSION The results of this study show that MBM for BE is safe with a low risk of serious adverse events. In addition, most of the adverse events could be managed endoscopically or conservatively. The number of resections was an independent risk factor for postprocedural bleeding.
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Affiliation(s)
- Kamar Belghazi
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Norman Marcon
- Department of Gastroenterology, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Christopher Teshima
- Department of Gastroenterology, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Kenneth K Wang
- Department of Gastroenterology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Reza V Milano
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nahid Mostafavi
- Biostatistical Unit, Department of Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael B Wallace
- Department of Gastroenterology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Pujan Kandel
- Department of Gastroenterology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Farzan Bahin
- Department of Gastroenterology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Martin A Everson
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Rehan Haidry
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Gregory G Ginsberg
- Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gene K Ma
- Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, Cancer Institute, Rotterdam, the Netherlands
| | - Krish Ragunath
- Nottingham Digestive Diseases Centre & NIHR Biomedical Research Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | - Jacobo Ortiz-Fernandez-Sordo
- Nottingham Digestive Diseases Centre & NIHR Biomedical Research Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | | | - Stefan Seewald
- Department of Gastroenterology, GastroZentrum Hirslanden Zürich, Switzerland
| | - Bas L Weusten
- Department of Gastroenterology and Hepatology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, KU Leuven, Belgium
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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