Incidence of food residue interfering with postoperative endoscopic examination for gastric pull-up after esophagectomy

Abstract

IntroductionEsophageal cancer is the fifth most common cause of cancer-related death in men and the eighth most common cause in women, worldwide [1]. Because of perioperative chemotherapy and/or radiation therapy, the prognosis of patients with resectable esophageal cancer has improved, and the 5-year survival rate has been reported to be 40-50 % [2, 3]. As esophagectomized patients survive longer, the incidences of metachronous cancer of their gastric pull-up are now a challenge because the majority of patients undergo gastric pull-up reconstruction [4,5]. Once the cancer reaches an advanced stage, patients require the surgical resection of the gastric pull-up and re-reconstruction with an intestinal segment [6,7]. Therefore, periodic surveillance endoscopy is required to detect the cancer at an early stage and to allow its removal by endoscopic mucosal resection or endoscopic submucosal dissection [8,9].Appropriate endoscopic preparation is important for the observation of the entire surface of the upper gastrointestinal tract for any suspicious lesions. The presence of food residue can obscure the tract surface, resulting in overlooked lesions or a requirement of reexamination [10,11]. In spite of appropriate preparation, food residue that interferes with the examination is occasionally observed in an operated stomach because of its gastro-pyloric hypomotility [12]. However, if the risk factors for food residue are determined, patients at high risk for presenting food residue can be prepared more carefully for a higher quality endoscopic examination. Although the incidence of food AbstractBackground In spite of appropriate preparation, food residue that interferes with endoscopic examination is occasionally observed in an operated stomach. The present study aimed to elucidate the incidence of such food residue and determine its risk factors in gastric pull-up after esophagectomy. Methods A total of 116 esophagectomized patients underwent the first postoperative endoscopy to survey their gastric pull-up with a median interval of 14 months (range 6-24) after the surgery. Fasting time was 13-16 h before the examination. The amount of food residue was retrospectively classified from Grade 0 (no food residue) to Grade 4 (a large amount of food residue) by two expert endoscopists. Results Among the 116 patients, 73 patients were classified as Grade 0, 23 patients as Grade 1, 10 patients as Grade 2, 9 patients as Grade 3, and 1 patient as Grade 4. Food residue (≥Grade 2) that interfered with the examination was observed in 20 patients (17.2 %). There was no significant association between the food residue and patient baseline characteristics. Conclusion The food residue interfering with postoperative endoscopic examination was observed in 17.2 % of all surveyed gastric pull-ups.

CT scan and magnetic resonance diffusion‑weighted imaging in the diagnosis and treatment of esophageal cancer

“…The manifested largest and most clear sections of esophageal lesions were selected as the region of interest (ROI), and the ROI of each ADC image should be selected in the same area. Each ROI was measured 3 times, and the average value was taken as the final ADC value of each ROI ( 6 ).…”