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Columnar epithelium morphology after esophagectomy: clinical insight into the development of Barrett’s esophagus

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Abstract

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.

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References

  1. Li Y, Martin RC. Reflux injury of esophageal mucosa: experimental studies in animal models of esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. Dis Esophagus. 2007;20:372–8.

    Article  Google Scholar 

  2. Mukaisho K, Miwa K, Hattori T, et al. Gastric carcinogenesis by duodenal reflux through gut regenerative cell lineage. Dig Dis Sci. 2003;48:2153–8.

    Article  Google Scholar 

  3. Dunn LJ, Shenfine J, Griffin SM. Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review. Dis Esophagus. 2015;28:32–41.

    Article  CAS  Google Scholar 

  4. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;3:87–97.

    Article  Google Scholar 

  5. Franchimont D, Covas A, Brasseur C, Van Laethem J-L, El-Nakadi I, Deviere J. Newly developed Barrett’s esophagus after subtotal esophagectomy. Endoscopy. 2003;35:850–3.

    Article  CAS  Google Scholar 

  6. O’Riordan J, Tucker O, Byrne P, et al. Factors influencing the development of Barrett’s epithelium in the esophageal remnant postesophagectomy. Am J Gastroenterol. 2004;99:205–11.

    Article  Google Scholar 

  7. da Rocha J, Ribeiro U, Sallum R, Szachnowicz S, Cecconello I. Barrett’s Esophagus (BE) and carcinoma in the esophageal stump (ES) after esophagectomy with gastric pull-up in achalasia patients: a study based on 10 years follow-up. Ann Surg Oncol. 2008;15:2903–9.

    Article  Google Scholar 

  8. D’Journo X, Martin J, Rakovich G, et al. Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition. Ann Surg. 2009;249:262–8.

    Article  Google Scholar 

  9. Nishimura K, Tanaka T, Tanaka K, et al. Refluxesophagitisand columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy). Dis Esophagus. 2010;23:94–9.

    Article  CAS  Google Scholar 

  10. Tsiouris A, Hammond Z, Velanovich V. Barrett’s esophagus after resection of the gastroesophageal junction: effects of concomitant fundoplication. World J Surg. 2011;35:1867–72.

    Article  Google Scholar 

  11. Aly A, Jamieson GG, Watson DI, et al. An antireflux anastomosis following esophagectomy: a randomized controlled trial. J Gastrointest Surg. 2010;14:470–5.

    Article  Google Scholar 

  12. Yuasa N, Sasaki E, Ikeyama T, Miyake H, Nimura Y. Acid and duodenogastroesophageal reflux after esophagectomy with gastric tube reconstruction. Am J Gastroenterol. 2005;100:1021–7.

    Article  Google Scholar 

  13. Gutschow C, Vallböhmer D, Stolte M, et al. Adenocarcinoma developing indenovo Barrett’s mucosa in the remnant esophagus after esophagectomy: clinical and molecular assessment. Dis Esophagus. 2008;21:E6–E8.

    Article  CAS  Google Scholar 

  14. Wolfsen H, Hemminger L, DeVault K. Recurrent Barrett’s esophagus and adenocarcinoma after esophagectomy. BMC Gastroenterol. 2004;4:18.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Toshiro Iizuka, Yugo Suzuki, Daisuke Kikuchi & Yoshio Hoshihara

  2. Department of Gastrointestinal Surgery, Toranomon Hospital, Tokyo, Japan

    Yu Ohkura & Masaki Ueno

  3. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Toshiro Iizuka

  4. Department of Gastroenterology, Nippon Medical School Hospital, Tokyo, Japan

    Yoshio Hoshihara

Authors
  1. Toshiro Iizuka
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  2. Yugo Suzuki
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  3. Daisuke Kikuchi
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  4. Yoshio Hoshihara
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  5. Yu Ohkura
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  6. Masaki Ueno
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Correspondence to Toshiro Iizuka.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki declaration of 1964 and later versions.

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Iizuka, T., Suzuki, Y., Kikuchi, D. et al. Columnar epithelium morphology after esophagectomy: clinical insight into the development of Barrett’s esophagus. Esophagus 17, 392–398 (2020). https://doi.org/10.1007/s10388-020-00742-9

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  • DOI: https://doi.org/10.1007/s10388-020-00742-9

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