Columnar epithelium morphology after esophagectomy: clinical insight into the development of Barrett's esophagus.
Aged
Aged, 80 and over
Anastomosis, Surgical
/ adverse effects
Barrett Esophagus
/ physiopathology
Case-Control Studies
Duodenogastric Reflux
/ complications
Endoscopy, Digestive System
/ methods
Epithelium
/ pathology
Esophagectomy
/ adverse effects
Esophagitis, Peptic
/ complications
Female
Gastric Acid
/ chemistry
Humans
Male
Middle Aged
Multivariate Analysis
Plastic Surgery Procedures
/ methods
Retrospective Studies
Columnar epithelium
Esophagectomy
Gastric tube reconstruction
Ileocolic interposition
Reflux esophagitis
Journal
Esophagus : official journal of the Japan Esophageal Society
ISSN: 1612-9067
Titre abrégé: Esophagus
Pays: Japan
ID NLM: 101206627
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
07
02
2020
accepted:
27
04
2020
pubmed:
10
5
2020
medline:
14
8
2021
entrez:
9
5
2020
Statut:
ppublish
Résumé
The presence of Barrett's mucosa in the esophageal remnant is a result of post-esophagectomy anastomotic site exposure to gastric acid and is regarded as a human model of Barrett's esophagus onset. Here, we attempted to clarify the relationship between duodenogastric reflux and formation of columnar epithelium by following the changes over time after esophagectomy. A total of 96 patients underwent esophagectomy due to superficial cancer from April 2000 to March 2018 were included in this study. Cases were divided into two groups according to the reconstruction technique after esophagectomy as either the gastric pull-up (Ga) group and ileocolonic interposition (Ic) group. Previously obtained endoscopic pictures of the cases were reviewed retrospectively and chronologically. There were 24 cases of columnar epithelium in the Ga group (42%) and 1 in the Ic group (2.6%) (P < 0.01) with 32 reflux cases (56%) in the Ga group and 1 (2.6%) in the Ic group (P < 0.01). Reflux precedes the development of columnar epithelium in both the Ga- and Ic groups. Multivariate analysis revealed surgical technique (odds ratio 10.6, 95% CI 1.2-97.5, P = 0.037) and reflux (odds ratio 4.5, 95% CI 1.3-15.6, P = 0.0017) as risk factors. The development of columnar epithelium was preceded by reflux comprising principally gastric acid and was strongly associated with a strong inflammatory state.
Sections du résumé
BACKGROUND
The presence of Barrett's mucosa in the esophageal remnant is a result of post-esophagectomy anastomotic site exposure to gastric acid and is regarded as a human model of Barrett's esophagus onset. Here, we attempted to clarify the relationship between duodenogastric reflux and formation of columnar epithelium by following the changes over time after esophagectomy.
METHODS
A total of 96 patients underwent esophagectomy due to superficial cancer from April 2000 to March 2018 were included in this study. Cases were divided into two groups according to the reconstruction technique after esophagectomy as either the gastric pull-up (Ga) group and ileocolonic interposition (Ic) group. Previously obtained endoscopic pictures of the cases were reviewed retrospectively and chronologically.
RESULTS
There were 24 cases of columnar epithelium in the Ga group (42%) and 1 in the Ic group (2.6%) (P < 0.01) with 32 reflux cases (56%) in the Ga group and 1 (2.6%) in the Ic group (P < 0.01). Reflux precedes the development of columnar epithelium in both the Ga- and Ic groups. Multivariate analysis revealed surgical technique (odds ratio 10.6, 95% CI 1.2-97.5, P = 0.037) and reflux (odds ratio 4.5, 95% CI 1.3-15.6, P = 0.0017) as risk factors.
CONCLUSIONS
The development of columnar epithelium was preceded by reflux comprising principally gastric acid and was strongly associated with a strong inflammatory state.
Identifiants
pubmed: 32383128
doi: 10.1007/s10388-020-00742-9
pii: 10.1007/s10388-020-00742-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM