Clinical characteristic of esophageal cancer without lugol‐voiding lesions in the background esophagus

Abstract

Lugol chromoendoscopy is useful for the detection of early esophageal squamous cell cancer (ESCC). Multiple lugol-voiding lesions (LVLs) on lugol chromoendoscopy are associated with a very high risk of multiple cancers arising in the esophagus. Due to the widespread use of narrow band image technology in many institutions, esophageal cancer without LVLs in the background esophagus is sometimes detected. This retrospective study aims to clarify the clinical characteristic of esophageal cancer without LVLs in the background esophagus. A total of 191 consecutive patients with 204 ESCCs had undergone endoscopic submucosal dissection (ESD) from 2011 and 2014. Amongst these lesions, the number of LVLs in the background esophagus per endoscopic view was counted excluding main lesion, and the grading was divided into no LVLs ESCC (nL-ESCC) group and LVLs ESCC (L-ESCC) group. This study evaluated the clinical characteristics and the cumulative incidence of metachronous ESCC after ESD in both groups. Thirty-six patients with 36 lesions and 155 patients with 168 lesions were separated into the nL-ESCC group and L-ESCC group, respectively. On multivariate analysis, the nL-ESCC group was found to be more common in females, who were nondrinkers, or with erosive esophagitis. During follow-up periods, the cumulative incidence of metachronous ESCC at 3-years was 14.4% and 0.00% in the L-ESCC and nL-ESCC groups, respectively (P < 0.01). Our study showed that esophageal cancer without LVLs in the background esophagus was mostly occurred in females, who were non-drinkers, or with erosive esophagitis, which are uncommon features of ESCC.

Endoscopic Features of Superficial Esophageal Squamous Cell Carcinoma in Patients with Very Low Risk Factors (Female, Nondrinking, and Nonsmoking): A Case-Control Study

“…The authors suggested a genetic predisposition to carcinogenesis. Kuwabara et al [25] reported that esophageal cancer without LVLs in the background esophagus likely has a longitudinal shape with jaggy like thunder, which was named “thunder-shaped LVLs.” They focused on the relationship between development of ESCC and reflux esophagitis in patients with no LVLs (LVL grade A) and assumed that persistent esophageal reflux and retention of refluxed food may contribute to the development of ESCC. Although the present study showed no statistically significant difference in the frequency of erosive esophagitis between the very low-risk group and the any-risk group, the ratio of symptomatic patients was significantly higher in the very low-risk group; this may reflect the difference in the frequency of esophageal reflux between the 2 groups.…”

Clinicopathological and genomic features of superficial esophageal squamous cell carcinomas in nondrinker, nonsmoker females

“…The posterior wall of the mid-thoracic esophagus is where the refluxed stomach acid and contents are retained in the supine position. 35 Therefore, based on morphology and location, it is speculated that retention of refluxed gastric acid and stomach contents in the posterior wall of the mid-thoracic F I G U R E 3 Alteration profiling of 32 lesions in the NDNS group and 37 in the DS group. The main panels contain the mutation patterns of 40 genes with more than 4% somatic mutations from 32 and 37 lesions in the NDNS and DS groups, respectively.…”

“…In the current study, the characteristic endoscopic finding of ESCC in nondrinking, nonsmoking women was longitudinal morphology with keratinization of the posterior wall of the mid‐thoracic esophagus. The posterior wall of the mid‐thoracic esophagus is where the refluxed stomach acid and contents are retained in the supine position 35 . Therefore, based on morphology and location, it is speculated that retention of refluxed gastric acid and stomach contents in the posterior wall of the mid‐thoracic esophagus led to the occurrence of ESCC in nondrinking, nonsmoking women.…”