scholarly journals Is There an Increasing Incidence of Gastroesophageal Junctional Adenocarcinoma and Barrett Esophagus in Asia? A Review of Diagnostic Conundrums

Digestion ◽  
2021 ◽  
Vol 103 (1) ◽  
pp. 37-44
Author(s):  
Phei Oon Tan ◽  
Alex Yu Sen Soh ◽  
Chika Kusano ◽  
Yeong Yeh Lee ◽  
Takuji Gotoda
Keyword(s):  
Paradigm Shift ◽  
Treatment Approach ◽  
Gastroesophageal Junction ◽  
Barrett Esophagus ◽  
Tissue Sampling ◽  
Surveillance Strategy ◽  
Endoscopic Techniques ◽  
Increasing Trend ◽  
Epidemiology Data ◽  
Asian Pacific

<b><i>Background:</i></b> Epidemiology data of gastroesophageal junction (GEJ) cancers in Asia are extremely scarce. It is hardly registered by any cancer registry in the region, and only a few reports are available. Based on existing literature works, the overall trend indicates similar or gradually increasing GEJ cancers in Asia but comparably less than the West. The increasing trend in Asia is likely a result of rising risk factors, especially of gastroesophageal reflux disease and obesity. <b><i>Summary:</i></b> However, epidemiology data may be misleading due to several contentious diagnostic issues. The diagnostic conundrums are due to inherent complexity of the GEJ as a functional and pathological unit. Challenging diagnostic issues in Asia include the following: nonstandardized landmark of the GEJ, misclassification of Barrett esophagus, targeted versus nontargeted tissue sampling, histopathology disagreement and challenges in screening or surveillance of dysplastic BE and early GEJ cancer. The recent Asian-Pacific survey led by the Asian Barrett Consortium (ABC) has provided useful insights into these contentious issues. A key learning point from these diagnostic limitations is that the awareness of the disease and adherence to existing recommendations or guidelines are poor in the region. <b><i>Key Messages:</i></b> Standardization in diagnostic methodology is vital for accurate epidemiology data, and this can only come from better awareness and adherence through educational and international efforts. Last, surveillance strategy may need a paradigm shift from a purely diagnostic approach to a combined targeted surveillance and treatment approach using novel endoscopic techniques.

Minimally Invasive Esophageal Procedures

2020 ◽  
Author(s):  
Jon O. Wee
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Minimally Invasive ◽  
Reflux Disease ◽  
Paraesophageal Hernia ◽  
Nissen Fundoplication ◽  
Gastroesophageal Junction ◽  
Outcome Evaluation ◽  
Barrett Esophagus ◽  
Asymptomatic Patients

In most instances, laparoscopy has replaced open procedures as the standard of care. Nevertheless, equipoise remains in the literature regarding the benefits of surgery compared with alternative treatment strategies such as medications in the case of gastroesophageal reflux disease (GERD) or endoscopic procedures in the case of achalasia. According to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines published in 2010, indications for surgery include (1) failure of medical management, (2) patient preference, (3) complications of GERD (Barrett esophagus, peptic stricture), and (4) extraesophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration). This chapter is organized by surgical procedure, all of which are derivatives of the laparoscopic Nissen fundoplication. In this chapter, the authors focus on minimally invasive surgical approaches to the treatment of the following benign esophageal disorders: GERD, achalasia, and paraesophageal hernias. New in this chapter is the in-depth coverage of laparoscopic paraesophageal hernia repair. The majority of patients with paraesophageal hernias are asymptomatic, and their hernias are found incidentally with a retrocardiac gastric bubble on an upright chest x-ray or herniated gastroesophageal junction seen on a chest or abdominal computed tomographic scan. For patients who are symptomatic, surgical repair is indicated as there is no medical treatment for this mechanical problem. For asymptomatic patients, clinical judgment needs to be used. All surgical procedures are covered by preoperative evaluation, operative planning, and operative technique, with a troubleshooting note for every step. Procedure complications, postoperative care, and outcome evaluation follow each procedure, listing the most current reports and data. This review contains 10 figures, 9 tables and 49 references Keywords: Minimally invasive surgery, esophagectomy, myotomy, gastroesophageal reflux disease, Barrett esophagus, Nissen fundoplication, fundoplication, paraesophageal hernia

Diagnostic Challenges in the Pathologic Evaluation of Barrett Esophagus

2010 ◽  
Vol 134 (11) ◽  
pp. 1589-1600 ◽  
Author(s):  
Rhonda K. Yantiss
Keyword(s):  
Relevant Literature ◽  
Gastroesophageal Junction ◽  
Endoscopic Examination ◽  
Distal Esophagus ◽  
Barrett Esophagus ◽  
Neoplastic Progression ◽  
Tissue Samples ◽  
Pathologic Evaluation ◽  
Biopsy Interpretation ◽  
Immunohistochemical Studies

Abstract Context.—Barrett esophagus represents an unstable epithelium resulting from chronic gastroesophageal reflux disease. Patients with Barrett esophagus routinely undergo endoscopic examination to detect dysplasia and early carcinoma. Although appropriate classification of Barrett esophagus and neoplasia is usually straightforward, persistent esophageal inflammation may induce epithelial changes that mimic, or mask, dysplasia. Recent data also indicate that specific molecular changes occur in nondysplastic Barrett mucosa and herald the development of dysplasia and/or carcinoma. Objective.—To describe problematic aspects of biopsy interpretation in tissue samples of the gastroesophageal junction and distal esophagus, including the diagnostic criteria for Barrett esophagus, the importance of the gastric cardia, and pitfalls to the diagnosis of dysplasia. Ancillary studies that have recently emerged as potential adjuncts to the evaluation of patients with Barrett esophagus will be briefly discussed. Data Sources.—A comprehensive review of the relevant literature indexed in PubMed (National Library of Medicine) was performed. Conclusions.—Barrett esophagus is currently defined as the presence of intestinal metaplasia in samples obtained from an endoscopically evident abnormality in the distal esophagus. Diagnosis and grading of dysplasia in mucosal biopsies remain the most reliable method to assess risk for neoplastic progression, but its classification may be hindered by superimposed inflammatory changes and suffers from considerable interobserver variability. Therefore, immunohistochemical studies and molecular assessment for TP53, CDKN2A, and DNA content abnormalities have emerged as potential adjuncts to the detection of dysplasia.

Gastroesophageal Junction Tumors Does Location Determine Treatment?

2017 ◽  
Author(s):  
Emily L. Siegel ◽  
Miguel Burch
Keyword(s):  
Study Design ◽  
Clinical Case ◽  
Classification Scheme ◽  
Treatment Approach ◽  
Gastroesophageal Junction ◽  
Design Study ◽  
Appropriate Treatment ◽  
Study Intervention ◽  
Landmark Study

This chapter summarizes a landmark study in treatment of gastroesophageal (GE) junction tumors. Should an anatomically based classification scheme of GE tumors define the appropriate treatment approach for these tumors? Starting with that question, it describes the basis of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving possible gastrectomy and esophagectomy.

scholarly journals Comparative quality assessment of esophageal examination with transnasal and sedated endoscopy

2017 ◽  
Vol 05 (05) ◽  
pp. E340-E344 ◽  
Author(s):  
Nicholas Crews ◽  
Emmanuel Gorospe ◽  
Michele Johnson ◽  
Louis-Michel Wong Kee Song ◽  
David Katzka ◽  
...  
Keyword(s):  
Randomized Study ◽  
Gastroesophageal Junction ◽  
Research Unit ◽  
Quality Score ◽  
Endoscopic Techniques ◽  
Transnasal Esophagoscopy ◽  
Significant Difference ◽  
Feasible Option ◽  
Endoscopic Assessment ◽  
Scoring Tool

Abstract Background Unsedated transnasal esophagoscopy (TNE) may offer a less expensive, mobile alternative to sedated esophagogastroduodenoscopy (EGD) for evaluations of reflux related complications. Comparisons of imaging quality by these methods are lacking. Methods Two reviewers evaluated videos of TNE and EGD procedures, performed during a community randomized study comparing endoscopic techniques. Subjects were randomized to EGD, TNE in endoscopy suite, or TNE in mobile research unit. Endoscopic quality was assessed using a validated scoring tool. Results In total, 115 videos (58 EGD, 28 endoscopy suite TNE, and 29 mobile TNE) were reviewed. Overall quality scores for TNE and EGD were excellent without a statistically significant difference (P = 0.30). There were no differences in gastroesophageal junction (GEJ) visualization scores, though EGD scored higher in esophageal passage (P < 0.05) and TNE scored higher in esophageal intubation (P < 0.05). There was no significant difference in any quality score between mobile TNE and gastrointestinal suite TNE. Conclusion Esophageal assessment with TNE or EGD was comparable in overall quality and GEJ visualization. TNE quality was not affected by procedure location. TNE is a feasible option for endoscopic assessment of reflux complications.

Long-term survivorship in gastric cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 14-14
Author(s):  
P. L. Kunz ◽  
M. A. Gubens ◽  
G. A. Fisher ◽  
J. M. Ford ◽  
D. Lichtensztajn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastroesophageal Junction ◽  
Intestinal Histology ◽  
Anatomic Site ◽  
Logistic Regression Models ◽  
Male Predominance ◽  
Kaplan Meier ◽  
Asian Pacific ◽  
Demographic Patterns

14 Background: Gastric cancer is the fourth most prevalent malignancy and second leading cause of cancer death worldwide. For all stages, gastric cancer is rapidly fatal with a 5-year survival rate of 25%. Of those patients who survive, very little is known about their demographic and tumor characteristics. Methods: Cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed between 1998 and 2005 were identified within the California Cancer Registry, a SEER registry. Univariate and multivariate logistic regression models were constructed predicting the outcome of survival to 3, 5 and 8 years based on demographic, disease and treatment variables. Results: Of the 47,049 patients with gastric or GEJ cancer, 38,380 (82%) died within 3 years of diagnosis, 8,669 (18%) survived at least 3 years, 5,336 (11%) survived at least 5 years, and 3,002 (6%) survived at least 8 years. The 5-year survivors had a median age at diagnosis of 67 years with a male predominance (64%). The majority were non-Hispanic whites (64%), followed by Asian/Pacific Islanders (23%), and Hispanics (18%). Most had localized (48%) or regional (41%) disease. In the multivariate model, odds of surviving to 5 years were highest with localized stage (odds datio=27), surgery (7.8), regional stage (5.9), fundus/body/antrum site (1.7), Asian/Pacific Islander race (1.5), intestinal histology (1.5), high SES (1.4), and well/moderately differentiated tumors (1.4). Kaplan-Meier curves for cause-specific death were examined by anatomic site and histology. Persons with tumors originating in the fundus/body/antrum had longer median OS compared to patients with tumors originating in the esophagus/cardia (15 vs. 12 months). Intestinal histology had longer median OS (30 months) compared to other or diffuse (both approx 12 months). Conclusions: Long-term survivors of gastric and GEJ cancer have distinct demographic patterns when compared to patients who died within three years. The multivariate analyses demonstrated that earlier stage, surgery, anatomic site (fundus/body), Asian race, intestinal histology, high SES, well/moderately differentiated tumors, and radiation were the strongest independent predictors of survival. No significant financial relationships to disclose.

Pattern of local-regional relapse and survival after bimodality therapy for esophageal cancer: Implications for the surveillance strategy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4083-4083 ◽  
Author(s):  
Kazuki Sudo ◽  
Lianchun Xiao ◽  
Roopma Wadhwa ◽  
Takashi Taketa ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Distant Metastases ◽  
Rank Test ◽  
Evidence Based ◽  
Test Results ◽  
Surveillance Strategy ◽  
Gastroesophageal Junction Cancer ◽  
Kaplan Meier ◽  
Regional Disease

4083 Background: Evidence for definitive chemoradiotherapy (bimodality therapy [BMT]) has been established for patients with esophageal and gastroesophageal junction cancer (EGEJC) who do not qualify for surgery. Surveillance for these patients is often recommended but the literature lacks guidance for an evidence-based surveillance strategy after BMT. Methods: We analyzed 276 patients with EGEJC who underwent BMT and had pre- and postchemoradiation endoscopic biopsies and imaging studies available for review. Patients who underwent planned surgery or salvage surgery (SS) within 6 months from BMT were excluded. We reviewed the pattern of relapse over time. Local-regional disease (LRD) after BMT was classified as regional disease (RD) or luminal-only disease (LD). Overall survival (OS) probabilities were estimated using the Kaplan-Meier method and compared using the log-rank test. Results: For 276 patients, the median follow-up time was 53.0 months (95% confidence interval [CI], 47.3-58.7). A total of 184 (66.7%) patients had a persistent disease or relapse after BMT: 120 distant metastases (43.5% of 276) and 64 LRD (23.2% of 276). Of 64 LRD, 58 (91%) were diagnosed within 2 years of BMT and 63 (98%) were diagnosed within 3 years (see Table). Twenty-three of 64 LRD patients underwent SS. For patients with SS, the median OS time from diagnosis of LRD was 58.0 months (95% CI, not reached), and that for patients without SS was 9.0 months (95% CI, 7.3-10.7); this difference was highly significant (p < 0.001). Conclusions: Our data suggest that 91% of LRD occurred within 2 years after BMT and the OS with SS for LRD was better than that without SS. These data can contribute to the development of an evidence-based surveillance strategy. [Table: see text]

scholarly journals Recent advances in liver transplantation with HCV seropositive donors

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 2151
Author(s):  
Soumya Murag ◽  
Brittany B. Dennis ◽  
Donghee Kim ◽  
Aijaz Ahmed ◽  
George Cholankeril
Keyword(s):  
Liver Transplantation ◽  
Paradigm Shift ◽  
Hcv Infection ◽  
Hcv Treatment ◽  
Direct Acting Antiviral ◽  
Recent Advances ◽  
Increasing Trend ◽  
Poor Outcomes ◽  
Direct Acting ◽  
Donor Policies

The paradigm shift from interferon-based to direct-acting antiviral (DAA) therapy for the treatment of hepatitis C virus (HCV) infection has revolutionized the field of liver transplantation. These advances in effective HCV treatment, along with the persistent shortage in available liver grafts, have encouraged investigators to assess the need for adopting more inclusive donor policies. Owing to the poor outcomes following liver transplantation with recurrent HCV infection, liver transplantation using HCV seropositive donors (non-viremic and viremic) had been restricted. However, as a result of the growing supply of HCV seropositive donors from the recent opioid epidemic along with the advent of efficacious DAA therapy to treat HCV recurrence, there has been an increasing trend to use HCV seropositive donors for both HCV seropositive and seronegative recipients. The review aims to discuss recent advances and associated outcomes related to the use of HCV seropositive grafts for liver transplantation.

The Genesis of Barrett Esophagus: Has a Histologic Transition From Gastroesophageal Reflux Disease–Damaged Epithelium to Columnar Metaplasia Ever Been Seen in Humans?

2005 ◽  
Vol 129 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Robert H. Riddell
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Molecular Mechanisms ◽  
Gastroesophageal Junction ◽  
Barrett Esophagus ◽  
Columnar Metaplasia ◽  
Alkaline Reflux ◽  
Protein Transcription ◽  
Multilayered Epithelium

Abstract Has a histologic transition from gastroesophageal reflux disease–damaged epithelium to columnar metaplasia ever been seen in humans? The answer to this question seems to be that it has but that we either do not readily recognize it or it is not readily recognizable with regular light microscopy. There are at least 3 possible mechanisms for the genesis of Barrett esophagus. The first is ulceration at the gastroesophageal junction with subsequent repair by an epithelium that differentiates into Barrett epithelium. The second is metaplasia through multilayered epithelium. The third is creeping columnar metaplasia at the Z-line proximally followed by intestinalization. These 3 hypotheses may not be mutually exclusive, and all may be operative, depending on the local circumstances, amount of inflammation, erosion, ulcers, healing, acid and alkaline reflux, and use of proton pump inhibitors. Any of the epithelial types involved could be stable and not progress. They might even be reversible, which may also in part explain the mosaic of epithelial types that typify Barrett esophagus, and may be modified by any of the molecular mechanisms that turn protein transcription on and off (eg, promoter methylation, mutations). These mechanisms ultimately may also be involved in the genesis of neoplastic transformation.

Minimally Invasive Esophageal Procedures

2020 ◽  
Author(s):  
Jon O. Wee
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Minimally Invasive ◽  
Reflux Disease ◽  
Paraesophageal Hernia ◽  
Nissen Fundoplication ◽  
Gastroesophageal Junction ◽  
Outcome Evaluation ◽  
Barrett Esophagus ◽  
Asymptomatic Patients

In most instances, laparoscopy has replaced open procedures as the standard of care. Nevertheless, equipoise remains in the literature regarding the benefits of surgery compared with alternative treatment strategies such as medications in the case of gastroesophageal reflux disease (GERD) or endoscopic procedures in the case of achalasia. According to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines published in 2010, indications for surgery include (1) failure of medical management, (2) patient preference, (3) complications of GERD (Barrett esophagus, peptic stricture), and (4) extraesophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration). This chapter is organized by surgical procedure, all of which are derivatives of the laparoscopic Nissen fundoplication. In this chapter, the authors focus on minimally invasive surgical approaches to the treatment of the following benign esophageal disorders: GERD, achalasia, and paraesophageal hernias. New in this chapter is the in-depth coverage of laparoscopic paraesophageal hernia repair. The majority of patients with paraesophageal hernias are asymptomatic, and their hernias are found incidentally with a retrocardiac gastric bubble on an upright chest x-ray or herniated gastroesophageal junction seen on a chest or abdominal computed tomographic scan. For patients who are symptomatic, surgical repair is indicated as there is no medical treatment for this mechanical problem. For asymptomatic patients, clinical judgment needs to be used. All surgical procedures are covered by preoperative evaluation, operative planning, and operative technique, with a troubleshooting note for every step. Procedure complications, postoperative care, and outcome evaluation follow each procedure, listing the most current reports and data. This review contains 10 figures, 9 tables and 49 references Keywords: Minimally invasive surgery, esophagectomy, myotomy, gastroesophageal reflux disease, Barrett esophagus, Nissen fundoplication, fundoplication, paraesophageal hernia

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