Oesophagitis is common in patients with achalasia after pneumatic dilatation

Leeuwenburgh, Ivonne; Dekken, H. van; Scholten, Pieter; Hansen, Bettina E.; Haringsma, Jelle; Siersema, Peter D.; Kuipers, Ernst J.

doi:10.1111/j.1365-2036.2006.02871.x

Cited by 27 publications

(24 citation statements)

References 21 publications

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“…In achalasia patients, it has been suggested that chronic food stasis leads to chronic inflammation, epithelial hyperplasia, multifocal dysplasia, and squamous cell carcinoma (SCC) [1,16,17]. Previous studies showed that it would take a mean of 24 (range 10–43) years to establish carcinoma after symptom onset, and 3 to 4 years for carcinoma to develop from dysplasia [1,18,19]. Goldblum et al noted that several epithelial abnormalities were seen in achalasia, including high-grade squamous dysplasia, superficial squamous cell carcinoma, and lymphocytic esophagitis [20], exclusively accompanied by diffuse squamous hyperplasia reflecting accelerated cellular turnover and proliferation.…”

Section: Discussionmentioning

confidence: 99%

Improvement of endocytoscopic findings after per oral endoscopic myotomy (POEM) in esophageal achalasia; does POEM reduce the risk of developing esophageal carcinoma? Per oral endoscopic myotomy, endocytoscopy and carcinogenesis

et al. 2013

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BackgroundPer oral endoscopic myotomy (POEM) has been reported to be a new therapeutic option for esophageal achalasia. The possibility that POEM could reduce the risk of developing esophageal squamous cell carcinoma was evaluated.MethodsThis was a single-centre, retrospective study. Fifteen consecutive patients with esophageal achalasia who underwent POEM in our institution between August 2010 and January 2012 were enrolled. Ultra-high magnification with endocytoscopy was performed, and both histopathological and immunohistochemical evaluations for Ki-67 and p53 were assessed before and 3 months after POEM.ResultsPOEM was successfully performed and effectively released the dysphagia symptom in all patients without severe complications. Subjective symptoms (mean Ekcardt score, before 7.4 vs. after 0.5, p<0.05) and manometric pressure studies (mean lower esophageal sphincter pressure), before 82.7 vs. after 22.9 mmHg, p<0.05) showed substantial improvement following POEM. The average numbers of esophageal epithelial nuclei before and after POEM on endocytoscopic images were 128.0 and 78.0, respectively (p<0.05). The mean Ki-67-positive ratio was 26.0 (median 25.4, range, 10.3-33.2) before and 20.7 (median 20.0, 13.1-29.9; p=0.07) after POEM, and the mean p53-positive ratio was 2.35 (median 2.61, 0.32-4.23) before and 0.97 (median 1.49, 0.32-1.56; p<0.05) after POEM. A significant positive correlation was seen between the number of nuclei and the Ki-67-positive ratio (p<0.05).ConclusionsPOEM appears to be an effective and less invasive treatment of choice against achalasia and may reduce the risk of esophageal carcinogenesis. Endocytoscopy can be useful for the assessment of esophageal cellular proliferation.

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Section: Discussionmentioning

confidence: 99%

Improvement of endocytoscopic findings after per oral endoscopic myotomy (POEM) in esophageal achalasia; does POEM reduce the risk of developing esophageal carcinoma? Per oral endoscopic myotomy, endocytoscopy and carcinogenesis

et al. 2013

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“…The most feared complication, esophageal perforation, occurred in 1.6% (range, 0.67-5.6%) of patients in a meta-analysis of 1,065 patients treated by experienced physicians [3,27]. After balloon dilation, the damaged LES allows gastric contents to more easily reflux into the esophagus, and up to 40% of patients develop chronic active or ulcerating esophagitis after dilatation [32,33,36], although only 4% are symptomatic [37].…”

Section: Dilatationmentioning

confidence: 97%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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“…These factors usually lead to chronic inflammation of the esophageal mucosa, which potentially increases the risk of hyperplasia, dysplasia, and esophageal cancer [2, 3]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma in Patients with Achalasia: Narrow-Band Imaging versus Lugol's Staining

Ide

Carneiro

Frazão

et al. 2013

Journal of Oncology

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Chromoendoscopy with Lugol's staining remains the gold standard technique for detecting superficial SCC. An alternative technique, such as narrow-band imaging (NBI), for “optical staining” would be desirable, since NBI is a simpler technique and has no known complications. In this study, we compare NBI without magnification and chromoendoscopy with Lugol's staining for detecting high-grade dysplasia and intramucosal esophageal squamous cell carcinoma (SCC) in patients with achalasia. This was a prospective observational study of 43 patients with achalasia referred to the Gastrointestinal Endoscopy Unit of the Hospital of Clinics, São Paulo, University Medical School, Brazil, from October 2006 to February 2007. Conventional examinations with white light, NBI, and Lugol staining were consecutively performed, and the suspected lesions were mapped, recorded, and sent for biopsy. The results of the three methods were compared regarding sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood value, and negative likelihood value. Of the 43 patients, one was diagnosed with esophageal squamous cell carcinoma, and it was detected by all of the methods. NBI technology without magnification has high sensitivity and negative predictive value for detecting superficial esophageal squamous cell carcinoma, and it has comparable results with those obtained with Lugol's staining.

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Oesophagitis is common in patients with achalasia after pneumatic dilatation

Cited by 27 publications

References 21 publications

Improvement of endocytoscopic findings after per oral endoscopic myotomy (POEM) in esophageal achalasia; does POEM reduce the risk of developing esophageal carcinoma? Per oral endoscopic myotomy, endocytoscopy and carcinogenesis

Improvement of endocytoscopic findings after per oral endoscopic myotomy (POEM) in esophageal achalasia; does POEM reduce the risk of developing esophageal carcinoma? Per oral endoscopic myotomy, endocytoscopy and carcinogenesis

SAGES guidelines for the surgical treatment of esophageal achalasia

Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma in Patients with Achalasia: Narrow-Band Imaging versus Lugol's Staining

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