The current standard Endoscopic Therapy (ET) for Visible Dysplastic Lesions (VDL) and Early Adenocarcinoma (EAC) in Barrett’s Esophagus (BE) is Submucosal Dissection (ESD) or Mucosal Resection (EMR) followed by Radiofrequency Ablation (RFA). However, data on long-term Complete Remission of Neoplasia (CRN) after radical endoscopic resection (R0 - defined as free deep margin) are limited. 

CRN is defined as the complete absence of endoscopic and histological evidence of dysplasia/EAC after ET during the follow up.

Recent studies indicate a substantial long-term risk of neoplastic recurrence, necessitating indefinite surveillance for patients previously treated for High-Grade Dysplasia (HGD) or EAC.

The study aim was to assess the long-term dysplasia/EAC recurrence rate after achieving CRN with ET.

From 2019 to November 2025 (median follow-up 24 months, range 9-74 months), 29 consecutive patients (25 M, 4 F) underwent ET for VDL or EAC in BE. Data on the baseline characteristics of BE and arising lesions, the endoscopic techniques employed and the post-resection histopathological findings were analyzed, along with the number of recurrences during the follow-up according to endoscopic european BE’s guidelines.

Among the 29 patients, 16 had EAC, 13 had VDL (8 Low-Grade Dysplasia - LGD; 5 High-Grade-Displasia - HGD). ESD was performed in 12 cases and EMR in 17 cases. En-bloc R0 resection was achieved in 28/29 of procedures (96.5%). The endoscopic resection wasn’t curative in 2 patients: one for a positive deep resection margin and the other for lymphovascular invasion and poorly differentiated EAC. The first patient underwent surgery with histopathological evidence of EAC, the second oncological treatment for age and comorbidities. 27 patients with R0 endoscopic resection underwent to follow up.

At first endoscopic follow-up before RFA, one EAC visible lesion was detected (metachronous EAC?) and 4 invisible dysplastic lesions (3 LGD, 1 HGD) at random biopsies. The patient with metachronous EAC underwent surgery.

Two local recurrences of early cancer developed on previous positive lateral margin at first endoscopic resection were detected. One patient was managed with radical surgery and the second with another EMR.  

Excluding the two patients who required surgery after non curative endoscopic resection and other two patients who underwent surgery for disease recurrence unfit for ET, CRN rate was achieved in 25/27 patients (92,6%).

These preliminary data, according to the last European Endoscopic BE’s guidelines, confirm ET as an effective treatment option for VDL and EAC on BE with a high mid-term CRN rate either as first line or as a rescue strategy.