Low-grade dysplasia (LGD) in Barrett’s esophagus (BE) carries a significant risk of progression to high-grade dysplasia (HGD) or adenocarcinoma, estimated at 9–13%/patient/year when LGD is confirmed by expert pathology (1). Although radiofrequency ablation (RFA) is recommended by ESGE guidelines, results remain imperfect and sometimes contradictory (2). Endoscopic mucosal resection (EMR) may offer both diagnostic and therapeutic advantages over ablative techniques. No prior study has specifically evaluated outcomes of EMR in confirmed LGD in BE. This study aimed to assess the efficacy and safety of EMR for confirmed LGD.

This retrospective multicenter study (2008–2023) included patients from three tertiary centers who underwent EMR for histologically confirmed LGD. Inclusion required LGD validated by two expert pathologists and confirmed on the resection specimen. The primary endpoint was absence of progression to HGD or adenocarcinoma. Secondary endpoints included eradication and recurrence rates of LGD and intestinal metaplasia, as well as procedural morbidity. Adjunctive therapies (RFA and/or APC) were allowed at the discretion of the endoscopist.

Fifty‑two patients (mean age 62.9 ± 10.3 years; 77% male) were included. Median Prague classification was C1M3, with visible nodules in two cases. EMR sessions per patient ranged from 1 to 5. Adjunctive treatment was applied in 46.2% of patients (RFA: 10; APC: 10; both: 4). Initial LGD eradication was achieved in 100% of patients. LGD recurred in 15.4% of cases (8 patients) after a mean of 30.5 months; seven of these patients underwent endoscopic retreatment with successful eradication, resulting in a final overall eradication rate of 98.1% after a mean follow-up of 54 ± 22.3 months. The last patient’s treatment began after the end of the study period. No progression to HGD or adenocarcinoma occurred. BE eradication was obtained in 65.4% of patients, with recurrence in 11.8%. Procedure‑related morbidity was 1.9% (one delayed bleeding episode), and delayed adverse events occurred in 15.4% (9.6% strictures, 5.8% dysphagia), all resolving spontaneously or after endoscopic therapy.

EMR appears to be a safe and effective treatment option for confirmed LGD in BE, achieving high initial and long‑term eradication rates without malignant progression over a mean 4.5‑year follow‑up. These findings support EMR as a promising therapeutic and diagnostic strategy in selected patients, warranting further prospective validation.