Esophageal carcinoma in achalasia patients managed with endoscopic submucosal dissection and peroral endoscopic myotomy: Japan Achalasia Multicenter Study

Abstract

Objectives Indications for peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) in patients with achalasia concomitant with esophageal carcinoma (EC) are unclear. This study aimed to clarify the role of POEM in cases of achalasia concomitant with EC and to elucidate the indications for ESD and efficient surveillance for EC. Methods We conducted a multicenter cohort study at 14 hospitals in Japan, including 3707 cases of achalasia‐related esophageal motility disorders (EMDs). Factors contributing to EC risk, the characteristics of EC, and clinical outcomes of POEM/ESD were analyzed. Results In patients undergoing POEM, screening and surveillance endoscopy throughout a 1‐year period resulted in diagnosis of 72.1% new EC cases. Of 62 patients with 123 ECs, 40.3% had multiple or metachronous lesions within 37.5 months. EC was predominantly observed in the middle thoracic esophagus (58.5%) and posteriorly (73.2%). POEM had comparable safety and efficacy in cases of concomitant EC even after ESD. Endoscopic en bloc resection was performed in 95.8% and 89.3% of ECs diagnosed before and after POEM, respectively (P = 0.351); however, ESD on the POEM‐line was impaired by fibrosis. Multivariate analysis revealed risk factors for EC, including regular alcohol consumption, a history of smoking, advanced age, and extended disease duration. Alcohol intake and smoking had a synergistic effect on EC development. Conclusions Screening and surveillance of POEM help in detecting EC. ESD is feasible in achalasia, although on the POEM‐line is challenging. Surveillance endoscopy for EC is recommended for cases with specific risks and a history of ECs.

Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan

“…This study was conducted at 13 high-volume centers as part of a more retrospective cohort study of EMD cases, including achalasia (Japan Achalasia multicenter study; JAMS). 21 , 22 The study protocol was approved by the ethics committee of the respective institutions ( Supplementary Table 1 ). In JAMS, EMD cases diagnosed using standard methods, including HRM, esophagography, and esophagogastroscopy, and treated between 2010 and 2020 were recruited.…”

Early esophageal carcinomas in achalasia patient after endoscopic submucosal dissection combined with peroral endoscopic myotomy: A case report

“…However, esophageal carcinoma is usually diagnosed at the advanced stage, because neoplasm symptoms are often hidden by the achalasia-induced dysphagia. Therefore, surveillance endoscopy is recommended for patients with achalasia, especially for patients with specific risks and a history of esophageal carcinoma[ 5 ]. Ohkura et al [ 6 ] reported that ESD for early esophageal carcinoma with achalasia is a safe and curative procedure, due to esophageal dilatation and wall thickening.…”

“…Ohkura et al [ 6 ] reported that ESD for early esophageal carcinoma with achalasia is a safe and curative procedure, due to esophageal dilatation and wall thickening. However, ESD on the POEM line is impaired by fibrosis[ 5 ]. Therefore, when compared to a staging operation, a one-off operation can reduce the risk of fibrosis-induced surgical complications.…”

Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study

“…T HIS MULTICENTER STUDY involving 14 highvolume centers was conducted as part of a larger retrospective cohort study (Japan Achalasia Multicenter Study, JAMS) in patients with EMDs including achalasia. 10,11 Patients diagnosed with EMDs using standard methods including HRM, esophagogram, and esophagogastroscopy and treated between 2010 and 2020 were enrolled in the JAMS.…”