Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Shimizu, Toshio; Fujisaki, Junko; Omae, Masami; Yamasaki, Akira; Horiuchi, Yusuke; Ishiyama, Akiyoshi; Yoshio, Toshiyuki; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Tsuchida, Takaaki

doi:10.1159/000486197

Cited by 24 publications

(22 citation statements)

References 25 publications

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“…Disease-specific survival was 97.7% (EAC) and 95.8% (ESCC), and overall survival was 96.6% (EAC) and 66.7% (ESCC) with over 2-year follow-up. These results are similar to an Asian single center experience with 91 patients with Barrett’s associated EAC[98].…”

Section: Be and Early Esophageal Cancersupporting

confidence: 88%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: “lessons learned”, “technical considerations” and “future opportunities”. Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett’s esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller’s myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett’s and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results ...

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Section: Be and Early Esophageal Cancersupporting

confidence: 88%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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“…24,25 Furthermore, in Europe and the United States, random biopsy based on the Seattle protocol remains the gold standard to identify dysplasia or adenocarcinoma before treatment. 27 Based on our data, multiple lesions and the ratio of lesions involving more than one half of the lumen were significantly higher in LSBE cases (Table 1). As LSBE is common in Europe and the United States, high-grade dysplasia and flat-type lesions are commonly detected.…”

Section: Discussionmentioning

confidence: 66%

“…In Japan, complete tumor resection by ESD is preferred, whereas in Europe and the United States, endoscopic mucosal resection for visible lesions combined with radio-frequency ablation for residual metaplasia epithelium is recommended for BEA. 27 A total of 86 patients who underwent ESD in the previous study were included in this study (SSBE: 68 of 78 cases; LSBE: 18 of 22 cases). 26 Conversely, Japanese endoscopists usually conduct an endoscopically targeted biopsy for a lesion suspected of adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we believe that ESD is a potential effective therapeutic option for esophageal neoplasms in patients with LSBE, as well as SSBE. 27 A total of 86 patients who underwent ESD in the previous study were included in this study (SSBE: 68 of 78 cases; LSBE: 18 of 22 cases). 27 Based on our data, multiple lesions and the ratio of lesions involving more than one half of the lumen were significantly higher in LSBE cases (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…27 A total of 86 patients who underwent ESD in the previous study were included in this study (SSBE: 68 of 78 cases; LSBE: 18 of 22 cases). 27 Based on our data, multiple lesions and the ratio of lesions involving more than one half of the lumen were significantly higher in LSBE cases (Table 1). Therefore, when diagnosing or treating s-BEA in LSBE, caution should be paid to lesions, including the accompanied type 0-IIb or multiple lesions.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic features of esophageal adenocarcinoma derived from short‐segment versus long‐segment Barrett's esophagus

Yamasaki

Shimizu

Kawachi

et al. 2019

J of Gastro and Hepatol

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Background and Aim The study aims to clarify the endoscopic features and clinicopathological differences in superficial Barret's esophageal adenocarcinoma (s‐BEA) derived from short‐segment Barrett's esophagus (SSBE) and long‐segment Barrett's esophagus (LSBE). Methods We reviewed data of 130 patients (141 lesions) with pathologically confirmed s‐BEA (SSBE: 95 patients and 95 lesions; LSBE: 35 patients and 46 lesions). We analyzed endoscopic and clinicopathological features of s‐BEA in patients with SSBE and LSBE. Results The distribution of lesions according to macroscopic findings were as follows (s‐BEA in SSBE vs LSBE): flat type (0‐IIb), 3.2% (3/95) vs 32.6% (15/46) (P < 0.001); accompanied type 0‐IIb, 2.1% (2/95) vs 21.7% (10/46) (P < 0.001); and complex type (0‐I + IIb, 0‐IIa + IIc, etc.), 30.5% (29/95) vs 50.0% (23/46) (P = 0.025). Complex‐type s‐BEAs had high incidences of T1b invasions and poorly differentiated components (simple type: 22.5% [20/89] and 18.0% [16/89]; complex type: 59.6% [31/52] and 44.2% [23/52], P < 0.001 and P = 0.002, respectively). In SSBE, 72.6% (69/95) of lesions were located at the right anterior wall (P = 0.01). All flat‐type or depressed‐type lesions derived from SSBE were identified as reddish areas, whereas only 65.2% (15/23) from LSBE were identified as reddish areas (P < 0.001). Conclusions In LSBE, flat‐type, accompanied‐type 0‐IIb, and complex‐type lesions were significantly more prevalent. Furthermore, complex‐type s‐BEAs tended to have T1b invasions and poorly differentiated components. S‐BEAs in LSBE should be more carefully evaluated on endoscopic appearance including flat‐type and complex‐type lesions than in SSBE.

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Comprehensive DNA methylation profiling of Barrett's esophagus and esophageal adenocarcinoma in Japanese patients

Shijimaya

Tahara

Yamazaki

et al. 2023

Molecular Carcinogenesis

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Molecular mechanisms of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) remain unclear in Japanese patients. Japanese EACs frequently have underlying short length BE: short‐segment BE (SSBE), for which, neoplastic potential remains unclear. We performed comprehensive methylation profiling of EAC and BE in Japanese patients, mostly comprised with SSBE. Using three different groups of biopsies obtained from non‐neoplastic BE from patients without cancer (n = 50; N group), with EAC (n = 27; ADJ group) and EAC (n = 22; T group), methylation statuses of nine candidate genes (N33, DPYS, SLC16A12, CDH13, IGF2, MLF1, MYOD1, PRDM5, and P2RX7) were examined by the bisulfite pyrosequencing. Reduced representation bisulfite sequencing was performed to characterize the genome‐wide methylation status in 32 samples (12 from N, 12 ADJ, and 8 from T groups). In the candidate approach, methylation levels of N33, DPYS, and SLC16A12 were higher in ADJ and T groups compared to that in N group. The ADJ group was an independent factor for higher DNA methylation in non‐neoplastic BE. The genome‐wide approach demonstrated an increase of hypermethylation from ADJ to T groups relative to N group near the transcription start sites. Among gene groups hypermethylated in ADJ and T groups (n = 645) and T group alone (n = 1438), 1/4 and 1/3 were overlapped with downregulated genes in the microarray data set, respectively. Accelerated DNA methylation is observed in EAC and underlying BE in Japanese patients, mostly comprised with SSBE, highlighting the potential impact of methylation in early carcinogenesis.

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Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Cited by 24 publications

References 25 publications

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Endoscopic features of esophageal adenocarcinoma derived from short‐segment versus long‐segment Barrett's esophagus

Comprehensive DNA methylation profiling of Barrett's esophagus and esophageal adenocarcinoma in Japanese patients

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