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A 14-Year Study of 398 Esophageal Adenocarcinomas Diagnosed Among 156,256 EGDs Performed at Two Large Hospitals: An Inlet Patch Is Proposed as a Significant Risk Factor for Proximal Esophageal Adenocarcinoma

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Abstract

Background

An association between inlet patches and proximal esophageal adenocarcinomas is currently suspected because of numerous case reports of simultaneous occurrence of both diseases.

Aims

To analyze whether inlet patches are significantly associated with proximal esophageal adenocarcinomas in a large population.

Methods

Computerized search of pathology and EGD reports revealed 398 cases of esophageal adenocarcinomas among 156,236 EGDs (performed on 106,510 patients) diagnosed by histopathology performed at Royal Oak/Troy, William Beaumont Hospitals, 2003–2016. Adenocarcinomas localized as distal, middle, or proximal; and characterized as associated versus unassociated with inlet patches. Medical records were reviewed. Endoscopic photographs, radiologic images, and pathologic slides were re-reviewed. Two researchers independently performed systematic computerized literature searches; cases of simultaneous diseases identified by consensus.

Results

Adenocarcinoma locations included: distal-381, middle-14, and proximal esophagus-3. Five patients had inlet patches with esophageal adenocarcinomas located at: distal-2, middle-0, and proximal esophagus-3 (relative frequency of inlet patches with cancers of distal/middle esophagus = 2/395 [.5%] vs. proximal esophagus = 3/3 [100%], p < .000001, 95% OR CI > 50.1, Fisher’s exact test). Cases of proximal esophageal adenocarcinomas within inlet patches included: (1) Seventy-eight-year-old man presented with dysphagia. Neck CT showed proximal esophageal mass. EGD revealed semi-circumferential, multinodular, 3.0 × 1.5 cm mass within inlet patch. Histopathology of biopsies revealed moderately-to-poorly differentiated adenocarcinoma. Patient received chemoradiotherapy and expired 2 years later. (2) Seventy-nine-year-old man presented with anorexia and weight loss. EGD demonstrated proximal esophageal mass within inlet patch. Histopathology of biopsies revealed poorly differentiated, signet ring cell adenocarcinoma. Chest CT revealed 3.4 × 2.1-cm-proximal esophageal mass. Patient expired 4 months later. (3) Sixty-year-old man presented with dysphagia. EGD revealed 4-cm-long, semi-circumferential, proximal esophageal mass within inlet patch. Histopathology of biopsies revealed poorly differentiated adenocarcinoma. Patient underwent emergency esophagectomy for esophageal perforation 2 weeks after initiating chemoradiotherapy, and died shortly thereafter. Literature review revealed 39 cases of simultaneous disease.

Study Limitations

Potential underreporting by endoscopists of inlet patches at EGD.

Conclusions

Study supplements 39 previously reported cases of simultaneous disease, by adding three new cases, and by novel report of statistically significant association between these two entities, which has important implications in the pathophysiology of proximal esophageal adenocarcinoma.

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Author information

Author notes

  1. Molly Orosey and Mitchell S. Cappell are equal primary authors.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA

    Molly Orosey & Mitchell S. Cappell

  2. Department of Pathology, William Beaumont Hospital, Royal Oak, MI, 48073, USA

    Mitual Amin

  3. Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA

    Mitual Amin

  4. Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA

    Mitchell S. Cappell

Authors
  1. Molly Orosey
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  2. Mitual Amin
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Contributions

MO performed the chart reviews of the patients, wrote the three case reports, performed the literature review, and wrote preliminary versions of the three tables. MA performed the entire pathology review, including retrospectively re-reviewing all the pathology slides. MC conceived the project, wrote the introduction and discussion, edited the case reports and tables, and acted as a mentor for MO who is a medical resident.

Corresponding author

Correspondence to Mitchell S. Cappell.

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Conflict of interest

None for all authors. This paper does not discuss any confidential pharmaceutical industry data reviewed by Dr. Cappell as a consultant for the United States Food and Drug Administration (FDA) Advisory Committee on Gastrointestinal Drugs. Dr. Cappell is a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. This work does not discuss any drug manufactured or marketed by AstraZeneca or Daiichi Sankyo.

IRB approval

Initially approved by William Beaumont Hospital IRB on 6/9/2016.

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Orosey, M., Amin, M. & Cappell, M.S. A 14-Year Study of 398 Esophageal Adenocarcinomas Diagnosed Among 156,256 EGDs Performed at Two Large Hospitals: An Inlet Patch Is Proposed as a Significant Risk Factor for Proximal Esophageal Adenocarcinoma. Dig Dis Sci 63, 452–465 (2018). https://doi.org/10.1007/s10620-017-4878-2

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