Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review

Abstract

Barrett's metaplasia is a well-recognized risk factor for esophageal adenocarcinoma. It is believed to develop in response to the injurious effects of gastroesophageal reflux. Following subtotal esophagectomy and reconstruction with a gastric conduit, many patients experience profound reflux into the remnant esophagus. Barrett's-like epithelium has been described in these patients, and they have been identified as a potential human model in which to study the early events in the development of metaplasia. This phenomenon also raises clinical concerns about the long-term fate of the esophageal remnant following surgery and the potential for further malignant change. This systematic review summarizes the literature on the prevalence and timing of Barrett's metaplasia occurring after esophagectomy, reviews the evidence regarding risk factors and malignant progression in such patients, and considers the implications for clinical practice.

Clonal transitions and phenotypic evolution in Barrett esophagus

“…To address this, bootstrapping analysis was performed on all of the biopsies in our cohort (Supplemental materials and methods) which showed that randomly sampling a larger number of glands from these biopsies would not alter the outcome of Shannon diversity (Supplemental Figure 7). Neo-BE biopsies showed no per-biopsy diversity whatsoever and the dominant phenotype observed was cardiac (n=22/31 biopsies in 13/19 patients) as has been observed before 23 . Specialized and corpus type glands were identified in a minority of patients (n=5/31 biopsies in 4/19 patients and n=4 biopsies in, n=4 patients respectively).…”

Oesophageal replacement with stomach: A personal series and review of published experience

“…Barrett's epithelium was found in 10 of 14 patients who had undergone oesophageal reconstruction using a gastric tube . A recent systematic review highlighted the dangers to children of gastric reconstruction following oesophagectomy, recommending routine endoscopic surveillance …”

“…Among studies of functional outcomes, anaemia was seen in 70% of children in one study, 49 while the other showed 33% anaemic but 100% with low ferritin. 8 The aetiology of the anaemia is iron deficiency caused by impaired iron absorption 75 and, in some cases, chronic blood loss from ulceration of the oesophageal remnant. The combination of an ulcerated oesophageal remnant and impaired iron absorption is a particularly intractable problem.…”

“…86 A recent systematic review highlighted the dangers to children of gastric reconstruction following oesophagectomy, recommending routine endoscopic surveillance. 75 One of our procedures followed a failed attempt at a Foker oesophageal mobilisation. 9 It is noticeable how often, in the reports of gastric transposition, the preceding procedure has been a failed Foker type of mobilisation.…”

Functional syndromes and symptom-orientated aftercare after esophagectomy

“…In this context, low intrathoracic anastomosis should generally be avoided due to the higher risk of reflux problems [ 12 ]. As a consequence of chronic reflux, severe esophagitis and meta- and dysplasia in terms of a neo-Barrett’s esophagus may occur [ 33 ], and even de novo adenocarcinoma in the residual esophagus has been reported [ 34 ]. Nevertheless, the pathophysiological role of acidic and bilious reflux components has not been conclusively clarified [ 35 ].…”