Columnar Metaplasia in the Esophageal Remnant After Esophagectomy

Dunn, L; Burt, Alastair D.; Hayes, Nicholas; Griffin, S. M.

doi:10.1097/sla.0000000000001591

Cited by 13 publications

(9 citation statements)

References 29 publications

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“…12,19 Additionally, many surgeons perform pyloroplasty as well with the operation for improved gastric emptying. 20 All these aforementioned factors contribute to the well-known reflux symptoms that patients endorse following esophagectomy.…”

Section: Discussion/surgerymentioning

confidence: 99%

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

Alwatari

Scheese

Gardner

et al. 2023

Foregut: The Journal of the American Foregut Society

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Patients undergoing foregut surgeries can have de novo findings or worsening of underlying upper gastrointestinal pathologies including Barrett’s esophagus and gastric intestinal metaplasia. These changes carry a potentially increased risk for malignancy development in the future raising the question of the utility of post-operative surveillance endoscopy after esophagectomy, bariatric and metabolic surgeries (Sleeve gastrectomy and Roux-en-Y Gastric Bypass), achalasia treatment, and anti-reflux surgery. In this narrative review, we conduct a literature exploration of available data on post-operative endoscopic surveillance findings following the procedures summarizing the prevalence of upper gastrointestinal pathologies and recommendations on the utility of postoperative endoscopy from established medical societies.

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Section: Discussion/surgerymentioning

confidence: 99%

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

Alwatari

Scheese

Gardner

et al. 2023

Foregut: The Journal of the American Foregut Society

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show abstract

“…Figure 2(e–h) present the pathological images of hematoxylin and eosin stain of the esophagus. In the esophageal tissue sections, the area containing nucleic acid is stained bluish violet, whereas the area containing protein is stained pink; the blue line separates the upper and bottom layers of the mucosa 21 – 23 . Figure 2(e) shows the image of normal esophagus tissue section, in which the tissue structure of squamous epithelium is well-preserved; in the upper mucosal layer, nuclear/cytoplasmic (N/C) ratio is reduced as the cytoplasm is increased from the substrate to the superficial layer.…”

Section: Resultsmentioning

confidence: 99%

Early identification of esophageal squamous neoplasm by hyperspectral endoscopic imaging

Syu

Jen

et al. 2018

Sci Rep

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Esophageal squamous neoplasm presents a spectrum of different diatheses. A precise assessment for individualized treatment depends on the accuracy of the initial diagnosis. Detection relies on comprehensive and accurate white-light, iodine staining, and narrow-band imaging endoscopy. These methods have limitations in addition to its invasive nature and the potential risks related to the method. These limitations include difficulties in precise tumor delineation to enable complete resection, inflammation and malignancy differentiation, and stage determination. The resolution of these problems depends on the surgeon’s ability and experience with available technology for visualization and resection. We proposed a method for identifying early esophageal cancerous lesion by endoscopy and hyperspectral endoscopic imaging. Experimental result shows the characteristic spectrum of a normal esophagus, precancerous lesion, canceration, and intraepithelial papillary capillary loop can be identified through principal component score chart. The narrow-band imaging (NBI) image shows remarkable spectral characteristic distribution, and the sensitivity and specificity of the proposed method are higher than those of other methods by ~0.8 and ~0.88, respectively. The proposed method enables the accurate visualization of target organs, it may be useful to capsule endoscope and telemedicine, which requires highly precise images for diagnosis.

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“…Another important issue addressed in this study focuses on the concern that current literature shows up to 50% of patients developing Neo-Barrett’s Esophagus above the anastomosis after Ivor-Lewis esophagectomy[ 31 ]. In addition, as we observed in a previous study, patients with known Barrett’s esophagus and adenocarcinoma have a higher risk of developing reflux-associated lesions in the remnant esophagus than patients with SCC.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy

Babic¹,

Müller²,

Gebauer³

et al. 2021

WJGO

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BACKGROUND There is no established correlation between 24-h esophageal pH-metry (Eso-pH) and the new laryngopharyngeal pH-monitoring system (Restech) as only small case series exist. Eso-pH was not designed to detect laryngopharyngeal reflux (LPR) and Restech may detect LPR better. We have previously published a dataset using the two techniques in a large patient collective with gastroesophageal reflux disease. Anatomically, patients after esophagectomy were reported to represent an ideal human reflux model as no reflux barrier exists. AIM To use a human reflux model to examine our previously published correlation in these patients. METHODS Patients after Ivor Lewis esophagectomy underwent our routine follow-up program with surveillance endoscopies, computed tomography scans and further exams following surgery. Only patients with a complete check-up program and reflux symptoms were offered inclusion into this prospective study and evaluated using Restech and simultaneous Eso-pH. Subsequently, the relationship between the two techniques was evaluated RESULTS A total of 43 patients from May 2016 - November 2018 were included. All patients presented with mainly typical reflux symptoms such as heartburn (74%), regurgitation (84%), chest pain (58%), and dysphagia (47%). Extraesophageal symptoms such as cough, hoarseness, asthma symptoms, and globus sensation were also present. Esophageal 24-hour pH-metry was abnormal in 88% of patients with a mean DeMeester Score of 229.45 [range 26.4-319.5]. Restech evaluation was abnormal in 61% of cases in this highly selective patient cohort. All patients with abnormal supine LPR were also abnormal for supine esophageal reflux measured by conventional Eso-pH. CONCLUSION Patients following esophagectomy and reconstruction with gastric interposition can ideally serve as a human reflux model. Interestingly, laryngopharyngeal reflux phases occur mainly in the upright position. In this human volume-reflux model, results of simultaneous esophageal and laryngopharyngeal (Restech) pH-metry showed 100% correlation as being explicable by one of our reflux scenarios.

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Columnar Metaplasia in the Esophageal Remnant After Esophagectomy

Cited by 13 publications

References 29 publications

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

Early identification of esophageal squamous neoplasm by hyperspectral endoscopic imaging

Gastrointestinal function testing model using a new laryngopharyngeal pH probe (Restech) in patients after Ivor-Lewis esophagectomy

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