Endoscopy 2020; 52(S 01): S157-S158
DOI: 10.1055/s-0040-1704485
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 09:00 – 09:30 Upper GI: Endoscopic diagnosis 1 ePoster Podium 6
© Georg Thieme Verlag KG Stuttgart · New York

INTESTINAL METAPLASIA IN PATIENTS WITH GASTRO-ESOPHAGEAL JUNCTION TUMORS: SHOULD PATIENTS BE MANAGED DIFFERENTLY?

I Marques de Sá
1   Instituto Português de Oncologia, Gastroenterology, Porto, Portugal
,
A Varelas
2   Instituto Português de Oncologia, Pathology, Porto, Portugal
,
A Laranjo
3   Hospital Espírito Santo de Évora, Gastroenterology, Évora, Portugal
,
AL Cunha
2   Instituto Português de Oncologia, Pathology, Porto, Portugal
,
PP Nunes
1   Instituto Português de Oncologia, Gastroenterology, Porto, Portugal
,
MD Ribeiro
1   Instituto Português de Oncologia, Gastroenterology, Porto, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Both the incidence for Barrett’s esophagus (BE) and gastro-esophageal junction (GEJ) tumors seems to be increasing. Interestingly, patients with intestinal metaplasia (IM) affecting the distal esophagus (eg BE) or at the GEJ are managed in opposite directions, with follow-up being mandatory for the former and the absence of further care recommended for the later. Also, the management of superficial lesions in GEJ depends on the presence or absence of BE, with EMR or ESD suggested, respectively. We aimed to determine the clinical features and prevalence of premalignant conditions in the surrounding mucosa among patients with GEJ cancer.

    Methods All consecutive patients surgically treated for GEJ adenocarcinomas in our center, between 2011 and 2018 and with their specimen retrievable (n=111) were retrospectively assessed. Clinical files were evaluated and pathology specimens reviewed to determine the mucosal changes in the surrounding mucosa in the distal esophagus, proximal corpus and cardia if not involved/distorted by the tumour (in 68 patients).

    Results Sixty nine percent of patients were male and in 17% gastroesophageal reflux noticeable. Also 39% had excess body weight and 53% current or past smoking history. IM was diagnosed in surrounding mucosa in 53 patients (48%) with: 5 (4.5%) affecting solely the distal esophagus (BE); 13 patients (12% out of 111 or 19% out of 68) with IM or multilayered epithelium (early stage of IM) in the cardia (“ultra-short BE”); and 33(30%) exclusively the proximal corpus. In 28 patients(25%) moderate to severe atrophic changes were also reported in proximal corpus.

    Conclusions Our study highlights that in most GEJ tumors a BE is not clearly identified and that a significant proportion of these patients present with atrophic changes (including IM) in proximal stomach. Future studies should be conducted namely including patients with early GEJ lesions to better determine the proper management for these increasingly diagnosed patients.


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