Endoscopic and histopathologic reflux-associated mucosal damage in the remnant esophagus following transthoracic esophagectomy for cancer—5-year long-term follow-up
| Autor: | Arnulf H. Hölscher, S Brinkmann, Marc Bludau, Hans F. Fuchs, M Meissner, Martin K. H. Maus, Henner Schmidt, Wolfgang Schröder, Jessica M. Leers |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Esophageal Mucosa Esophageal Neoplasms medicine.medical_treatment Long Term Adverse Effects Adenocarcinoma Gastroenterology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine medicine Humans Prospective Studies Esophagus Prospective cohort study Aged Retrospective Studies Aged 80 and over business.industry Reflux Cancer Retrospective cohort study General Medicine Middle Aged Esophageal cancer medicine.disease Esophagectomy medicine.anatomical_structure 030220 oncology & carcinogenesis Carcinoma Squamous Cell Gastroesophageal Reflux Female 030211 gastroenterology & hepatology business Follow-Up Studies |
| Zdroj: | Diseases of the Esophagus. 31 |
| ISSN: | 1442-2050 1120-8694 |
| DOI: | 10.1093/dote/dox115 |
| Popis: | Gastroesophageal reflux is a common problem following esophagectomy and reconstruction with gastric interposition. Despite a routine prescription of proton pump inhibitors, reflux-associated mucosal damage in the remnant esophagus is frequently observed. Purpose of this study is to evaluate mucosal damage in the esophageal remnant during long-term follow-up and to compare the prevalence of this damage between the subgroups of esophageal squamous cell and adenocarcinoma. All patients undergoing transthoracic Ivor-Lewis esophagectomy were prospectively entered in our IRB approved database. All patients underwent a routine check-up program with yearly surveillance endoscopies following esophagectomy. Only patients with a complete follow-up were included into this study. Endoscopic and histopathologic mucosal changes of the remnant esophagus were analyzed in close intervals. A total of 50 patients met the inclusion criteria, consisting of 31 adenocarcinomas (AC) and 19 squamous cell carcinomas (SCC). Mucosal damage was already seen 1 year after surgery in 20 patients macroscopically (43%) and in 21 patients microscopically (45%). At 5-year follow-up the prevalence for macroscopic and microscopic damage was 55% and 60%, respectively. The prevalence of mucosal damage was higher in AC patients than in SCC patients (1y-FU: 51% [AC] vs. 28% [SCC]; 5y-FU: 68% [AC] vs. 35% [SCC], P < 0.05). Newly acquired Barrett's esophagus was seen in 10 patients (20%) with two of those patients (20%) showing histopathologic proof of neoplasia. This study shows a high prevalence of reflux-associated mucosal damage in the remnant esophagus one year out of surgery and only a moderate increase in prevalence in the following years. Mucosal damage was more frequently seen in AC patients and the occurrence of de-novo Barrett's esophagus and de-novo neoplasia was high. Endoscopic surveillance with targeted biopsies seems to be an indispensable tool to follow patients after esophagectomy appropriately. |
| Databáze: | OpenAIRE |
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