Prospective, Randomized Trial Comparing En Bloc with Piecemeal Resection of Neoplasia in Barrett’s Esophagus (BEEPER)

Barrett’s esophagus, which occurs in patients with gastroesophageal reflux disease has prevalence of 1-3% in Western countries. Barrett’s esophagus can then develop into dysplasia (low-grade and high-grade) and ultimately into esophageal adenocarcinoma, which has yearly incidence of 0.1-0.3%. Esophagogastroduodenoscopy (EGD) enables careful examination of the esophagus for detection of Barrett’s esophagus, dysplastic changes and also endoscopic removal of dysplasia and early carcinoma. There are two main techniques for resection of dysplasia and early cancer – 1) endoscopic mucosal resection (EMR), which is performed in a piecemeal fashion using a snare and 2) endoscopic submucosal dissection (ESD), which is performed en bloc using an endoscopic knife. The current available data on comparison of these two resection methods are inconsistent and to date, there are no randomized trials directly comparing these two methods.

Primary outcome: To compare the rate of complete curative resection of Barrett’s esophagus with dysplasia/early esophageal cancer between EMR and ESD methods.

Inclusion criteria: Patients to be treated for neoplastic Barrett's esophagus by mucosal resection/dissection and following ablative therapy.

Study registration: ClinicalTrials.gov NCT03427346