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Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma

INTRODUCTION: The risk of lymph node metastases (LNM) in submucosal esophageal adenocarcinoma (EAC) patients is subject to debate. These patients might be treated endoscopically if the risk of LNM appears to be low. OBJECTIVE: The objective of this article is to evaluate the outcome of patients who...

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Autores principales: Künzli, HT, Belghazi, K, Pouw, RE, Meijer, SL, Seldenrijk, CA, Weusten, BLAM, Bergman, JJGHM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068782/
https://www.ncbi.nlm.nih.gov/pubmed/30083328
http://dx.doi.org/10.1177/2050640617753808
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author Künzli, HT
Belghazi, K
Pouw, RE
Meijer, SL
Seldenrijk, CA
Weusten, BLAM
Bergman, JJGHM
author_facet Künzli, HT
Belghazi, K
Pouw, RE
Meijer, SL
Seldenrijk, CA
Weusten, BLAM
Bergman, JJGHM
author_sort Künzli, HT
collection PubMed
description INTRODUCTION: The risk of lymph node metastases (LNM) in submucosal esophageal adenocarcinoma (EAC) patients is subject to debate. These patients might be treated endoscopically if the risk of LNM appears to be low. OBJECTIVE: The objective of this article is to evaluate the outcome of patients who underwent an endoscopic resection (ER) and subsequent endoscopic follow-up for a submucosal EAC. METHODS: All patients who underwent ER for submucosal EAC between January 2012 and August 2016 and were subsequently managed with endoscopic follow-up were retrospectively identified. Primary outcome was the number of patients diagnosed with LNM; secondary outcomes included intraluminal recurrences. RESULTS: Thirty-five patients (median age 68 years) were included: 17 low-risk (submucosal invasion <500 microns, G1–G2, no lymphovascular invasion (LVI)), and 18 high-risk (submucosal invasion >500 microns, and/or G3–G4, and/or LVI, and/or a tumor-positive deep resection margin (R1)) EACs. After a median follow-up of 23 (IQR 15–43) months, in which patients underwent a median of six (IQR 4–8) endoscopies and a median of four (IQR 2–8) endoscopic ultrasound procedures, none of the included patients were diagnosed with LNM. Five (14%) patients developed a local intraluminal recurrence a median of 18 (IQR 11–21) months after baseline ER that were treated endoscopically. CONCLUSIONS: In 35 patients with a submucosal EAC, no LNM were found during a median follow-up of 23 months. Endoscopic therapy may be an alternative for surgery in selected patients with a submucosal EAC.
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spelling pubmed-60687822018-08-06 Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma Künzli, HT Belghazi, K Pouw, RE Meijer, SL Seldenrijk, CA Weusten, BLAM Bergman, JJGHM United European Gastroenterol J Original Articles INTRODUCTION: The risk of lymph node metastases (LNM) in submucosal esophageal adenocarcinoma (EAC) patients is subject to debate. These patients might be treated endoscopically if the risk of LNM appears to be low. OBJECTIVE: The objective of this article is to evaluate the outcome of patients who underwent an endoscopic resection (ER) and subsequent endoscopic follow-up for a submucosal EAC. METHODS: All patients who underwent ER for submucosal EAC between January 2012 and August 2016 and were subsequently managed with endoscopic follow-up were retrospectively identified. Primary outcome was the number of patients diagnosed with LNM; secondary outcomes included intraluminal recurrences. RESULTS: Thirty-five patients (median age 68 years) were included: 17 low-risk (submucosal invasion <500 microns, G1–G2, no lymphovascular invasion (LVI)), and 18 high-risk (submucosal invasion >500 microns, and/or G3–G4, and/or LVI, and/or a tumor-positive deep resection margin (R1)) EACs. After a median follow-up of 23 (IQR 15–43) months, in which patients underwent a median of six (IQR 4–8) endoscopies and a median of four (IQR 2–8) endoscopic ultrasound procedures, none of the included patients were diagnosed with LNM. Five (14%) patients developed a local intraluminal recurrence a median of 18 (IQR 11–21) months after baseline ER that were treated endoscopically. CONCLUSIONS: In 35 patients with a submucosal EAC, no LNM were found during a median follow-up of 23 months. Endoscopic therapy may be an alternative for surgery in selected patients with a submucosal EAC. SAGE Publications 2018-01-29 2018-06 /pmc/articles/PMC6068782/ /pubmed/30083328 http://dx.doi.org/10.1177/2050640617753808 Text en © Author(s) 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Künzli, HT
Belghazi, K
Pouw, RE
Meijer, SL
Seldenrijk, CA
Weusten, BLAM
Bergman, JJGHM
Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title_full Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title_fullStr Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title_full_unstemmed Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title_short Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
title_sort endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068782/
https://www.ncbi.nlm.nih.gov/pubmed/30083328
http://dx.doi.org/10.1177/2050640617753808
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