Multiband mucosectomy safe and effective for treating Barrett's esophagus

An increasingly popular technique for removing lesions associated with Barrett's esophagus has been deemed a safe and effective treatment option in a study of more than 1,000 resections published this month in the European journal Endoscopy. The five-year study performed by a team of experienced endoscopists, is the largest prospective series to date to examine the safety and efficacy of multiband mucosectomy (MBM), an endoscopic procedure that is a simple and fast treatment option for Barrett's esophagus, a condition that can result from gastroesophageal reflux disease (GERD).

"This study is an important milestone, both for the patients undergoing these procedures and for the physicians who perform them," said Dr. Jacques Bergman, MD PhD, Head of the Department of Endoscopy, lead author of the study and head of the esophageal research team at the Academic Medical Center in Amsterdam, Netherlands. "With more than 1,000 resections and no perforations despite the absence of submucosal lifting, the conclusions of the five-year study support this technique as an effective option for treating these potentially cancerous lesions."

In patients with Barrett's esophagus, abnormal changes (lesions) occur in the tissue lining the esophagus. The condition frequently occurs in patients with GERD, in which the contents of the stomach, including digestive acids, rise into the esophagus. Barrett's esophagus can lead to a rare but deadly form of esophageal cancer, so physicians will typically recommend that patients with GERD undergo an endoscopic examination to identify and biopsy any lesions.

Lesions are removed in a procedure known as resection. The most widely used procedure is complicated and time-consuming and involves lifting the affected area with an injection of fluid. MBM allows for a procedure with fewer steps. In the MBM procedure, the abnormal mucosa is suctioned into a cap and a rubber band is released around it, creating a polyp-like bulge of tissue that is then easily resected by encircling the base with a specially configured snare. No submucosal lifting is required.

All MBM procedures in the study were performed with the Duette^® Multi-Band Mucosectomy kit from Cook Medical. The kit has a modified variceal band ligator as well as a hexagonal snare for performing resections. Because each ligator contains six rubber bands, the surgeon can perform up to six resections.

The MBM study was conducted between November 2004 and October 2009 at Academic Medical Center in Amsterdam and the Sint Antonius Hospital in Nieuwegein, Netherlands. The data include 170 patients who underwent 243 MBM procedures with a total of 1,060 resections. MBM effectively removed the targeted tissue with no perforations in more than 1,000 resections, with only a 3 percent incidence of bleeding during the procedure, events regarded as intrinsic to the resection along with some observed stenosis, and just a 2 percent incidence of delayed bleeding, which were effectively managed endoscopically.

"The Duette Multi-Band Mucosectomy kit is a very innovative and important device for patients who undergo EMR procedures, and we are delighted with the feedback we've received from physicians," said Barry Slowey, global business unit leader for Cook Medical's Endoscopy division. "We are pleased that such an important milestone for MBM resections has been accomplished. The data really speaks for itself."