Clinical Endoscopy

Original Articles

Progression to cancer in patients with confirmed dysplasia compared to dysplasia downgraded to non-dysplastic metaplasia in Barrett’s esophagus: a retrospective cohort study in Sweden: Peter Elbe, Åke Öst, Lennart Mellbom, Anders Thorell, Bengt Håkanson, Fredrik Klevebro, Mats Lindblad; Clin Endosc 2024;57(6):768-774. Published online November 25, 2024; DOI: https://doi.org/10.5946/ce.2023.313

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: This study aimed to clarify the risk of progression in patients with non-dysplastic Barrett’s esophagus (NDBE) and patients with confirmed low-grade dysplasia (LGD) and indefinite for dysplasia (IND) after an expert pathologist review of patients with BE with suspected dysplasia in a prospective cohort.
Methods
Patients with Barrett’s esophagus diagnosed with dysplasia at Ersta Hospital in Stockholm from 1998 to 2012 were included. The first dysplastic specimen in all patients was re-evaluated by two expert pathologists and classified as NDBE, LGD, IND, or cancer, including high-grade dysplasia. The incidence rates (IRs) and IR ratios were calculated with 95% confidence intervals.
Results
Of 423 patients with Barrett’s esophagus with dysplasia, 266 (62.9%) were re-classified as NDBE, 83 (19.6%) had LGD, 71 (16.8%) had IND, and 3 (0.7%) patients had cancer. During the follow-up, 34 (8%) patients developed cancer, most of them within five years, while others progressed after up to 25 years of surveillance. IRs for cancer among patients with NDBE was 0.41%/year compared to 1.84%/year for LGD (p<0.001) and 1.43%/year for IND (p=0.008).
Conclusions
Long-term risk of progression to cancer did not differ between patients with confirmed LGD and IND. These findings suggest that patients with IND should undergo similar management as patients with LGD.

Citations

Citations to this article as recorded by

Characteristics and Neoplastic Progression in Barrett’s Esophagus: A Large Population-Based Study from Iceland
Ken Namikawa, Melkorka Sverrisdottir, Hilmar Freyr Fridgeirsson, Hjalti Dagur Hjaltason, Helgi Kristinn Sigmundsson, Jon Gunnlaugur Jonasson, Einar Stefan Bjornsson, Magnus Konradsson
Diagnostics.2025; 15(6): 684. CrossRef

1,325 View
90 Download
2 Web of Science
1 Crossref

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan: Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto; Received April 2, 2024 Accepted July 29, 2024 Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.079 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

1,156 View
226 Download

Case Report

A rare case of esophageal mucoepidermoid carcinoma successfully treated via endoscopic submucosal dissection: So Eun Jeun, Kyung Bin Kim, Bong Eun Lee, Gwang Ha Kim, Moon Won Lee, Dong Chan Joo; Clin Endosc 2024;57(5):683-687. Published online June 18, 2024; DOI: https://doi.org/10.5946/ce.2024.051

Abstract PDF PubReader ePub: Esophageal mucoepidermoid carcinoma (EMEC) is a special subtype of esophageal malignancy, accounting for less than 1% of all cases of primary esophageal carcinoma. Pathologically, it consists of a mixture of adenocarcinoma and squamous cell carcinoma with mucin-secreting cells. Special staining for mucicarmine helps to diagnose EMEC. We present a rare case of EMEC successfully treated via endoscopic submucosal dissection (ESD). A 63-year-old man was referred to our tertiary hospital. On esophagogastroduodenoscopy, a 6-mm-sized subtle reddish depressed lesion was identified in the mid-esophagus. Diagnostic ESD was performed with a high suspicion of carcinoma. Histopathologic findings were consistent with EMEC which was confined to the lamina propria without lymphatic invasion. We plan to do a careful follow-up without administering adjuvant chemotherapy or radiotherapy. Due to the small volume of the lesion, establishing a diagnosis was difficult through forceps biopsy alone. However, by using ESD, we could confirm and successfully treat a rare case of early-stage EMEC.

3,150 View
219 Download

Review

Surveillance for metachronous cancers after endoscopic resection of esophageal squamous cell carcinoma: Ryu Ishihara; Clin Endosc 2024;57(5):559-570. Published online May 10, 2024; DOI: https://doi.org/10.5946/ce.2023.263

Search