Tu1598 Placement of Fully-Covered Self-Expanding Metal Esophageal Stents for Relief of Dysphagia Is Safe and Effective in Patients Receiving Neoadjuvant Cheomoradiation

Tu1596 Female Gender in Esophageal Intramucosal Adenocarcinoma Treated With Endoscopic Mucosal Resection: a Case Series Patrick T. Hickey*, Shashin Shah, Hiral Shah Lehigh Valley Health Network, Allentown, PA Background: Barrett’s esophagus (BE) is a premalignant esophageal condition which may lead to dysplasia and esophageal adenocarcinoma (EAC). The incidence of BE has increased in the last two decades. High-grade dysplasia (HGD) carries significant risk of progression to EAC. Patients with HGD and intramucosal adenocarcinoma (IMA) are increasingly treated with endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). Women have a lower risk of progression from BE to HGD or EAC. Females diagnosed with HGD are presumed to have an equal risk of progression to IMA or EAC. Herein we describe a case series of female patients with varying presentations of IMA treated with EMR and RFA.Cases:Patient 1: A 66 year old female with a history of pancreatic cancer and Whipple procedure had an esophagogastroduodenoscopy (EGD) showing gastroesophageal junction (GEJ) nodularity with HGD on biopsy. Subsequent EMR showed IMA with HGD at the margins. There was no nodularity on repeat EGD with negative biopsies. Follow up EGDs were done every 3 months with multiple EMR for GEJ nodularity, with negative pathology.Patient 2: A 75 year old female with a history of BE was found to have HGD and IMA on biopsy during surveillance EGD. EGD/EUS showed a para-aortic lymph node (!1 cm) and esophageal nodularity treated with EMR. She had BE with HGD, low-grade dysplasia (LGD), possible IMA, and negative lymph node FNA. Repeat EGD had no nodularity and the patient underwent RFA for BE. Repeat EGD showed GEJ irregularity and BE without dysplasia. She was treated with RFA on 3 separate occasions for short segment BE. Subsequent EGD with GEJ biopsy was free of pathology.Patient 3: A 75 year old female with a history of reflux and gastritis was found to have an irregular Z-line and esophagitis on EGD. Barrett’s mucosa with HGD (unable to exclude IMA) was found. An EGD showed GEJ nodularity treated with EMR at two sites. Pathology showed IMA with invasion into the muscularis mucosae with negative deep margins. Repeat EGD showed no residual BE. Discussion: BE is common, and found in 4% of patients undergoing EGD. It is estimated BE has a 20-fold increased risk of developing EAC. Visible noduleswithHGDsuggest amoreadvanced lesion;EMRupstages thediagnosis tocancer in up to 40% of cases. Currently endoscopic treatment with EMR/RFA is the standard of care for BE with HGD or IMA leading to a low recurrence rate. Female patients with esophageal HGD and/or IMA undergo EMR/RFA, but no data suggests their response is the same asmale patients. Further investigation of gender differencesmay reveal distinct incidence and response to EMR/RFA. Such differences would affect prognostication, timing of surveillance, and treatment. Our case opens a discussion to examine gender differences in esophageal HGD and IMA which should studied in the future.