Clinical Endoscopy

  • 제51권2호
  • /
  • Pages.161-166
  • /
  • 2018
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지
DOI QR코드

DOI QR Code

Retention Esophagitis as a Significant Clinical Predictor of Progression to Esophageal Cancer in Achalasia

  • Kim, Haewon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyojin (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, HeeSeung (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Shin, Yooju (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyunsung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Youn, Young Hoon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jie-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2017.06.01
  • 심사 : 2017.11.01
  • 발행 : 2018.03.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Chronic liquid and/or food stasis caused by retention esophagitis (RE) in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions. Methods: From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+) and 16 patients had no diagnostic findings of RE (RE-). Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia. Results: The symptom duration and transit delay were significantly longer in the RE+ group than in the RE- group. We found particularly high p53 positivity rates in the RE+ group (p<0.001). The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003). Conclusions: A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis.

키워드

참고문헌

  1. Moonen A, Boeckxstaens G. Current diagnosis and management of achalasia. J Clin Gastroenterol 2014;48:484-490.
  2. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013;108:1238-1249; quiz 1250. https://doi.org/10.1038/ajg.2013.196
  3. Ates F, Vaezi MF. The pathogenesis and management of achalasia: current status and future directions. Gut Liver 2015;9:449-463. https://doi.org/10.5009/gnl14446
  4. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014;383:83-93. https://doi.org/10.1016/S0140-6736(13)60651-0
  5. Streitz JM Jr, Ellis FH Jr, Gibb SP, Heatley GM. Achalasia and squamous cell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg 1995;59:1604-1609. https://doi.org/10.1016/0003-4975(94)00997-L
  6. Dunaway PM, Wong RK. Risk and surveillance intervals for squamous cell carcinoma in achalasia. Gastrointest Endosc Clin N Am 2001;11:425-434, ix.
  7. Leeuwenburgh I, Scholten P, Alderliesten J, et al. Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol 2010;105:2144-2149. https://doi.org/10.1038/ajg.2010.263
  8. Chino O, Kijima H, Shimada H, et al. Clinicopathological studies of esophageal carcinoma in achalasia: analyses of carcinogenesis using histological and immunohistochemical procedures. Anticancer Res 2000;20:3717-3722.
  9. Shields TW, LoCicero J 3rd, Reed CE, Feins RH. General thoracic surgery. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2009.
  10. Crookes PF, Corkill S, DeMeester TR. Gastroesophageal reflux in achalasia. When is reflux really reflux? Dig Dis Sci 1997;42:1354-1361. https://doi.org/10.1023/A:1018873501205
  11. Kiraly A, Illes A, Undi S, Varga G, Kalmar K, Horvath PO. Gastroesophageal reflux disease progressing to achalasia. Dis Esophagus 2005;18:355-358. https://doi.org/10.1111/j.1442-2050.2005.00515.x
  12. Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 1996;111:648-654. https://doi.org/10.1053/gast.1996.v111.pm8780569
  13. Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol 1994;18:327-337. https://doi.org/10.1097/00000478-199404000-00001
  14. Lehman MB, Clark SB, Ormsby AH, Rice TW, Richter JE, Goldblum JR. Squamous mucosal alterations in esophagectomy specimens from patients with end-stage achalasia. Am J Surg Pathol 2001;25:1413-1418. https://doi.org/10.1097/00000478-200111000-00009
  15. Minami H, Isomoto H, Miuma S, et al. New endoscopic indicator of esophageal achalasia: "pinstripe pattern". PLoS One 2015;10:e0101833. https://doi.org/10.1371/journal.pone.0101833
  16. Leeuwenburgh I, Gerrits MM, Capello A, et al. Expression of p53 as predictor for the development of esophageal cancer in achalasia patients. Dis Esophagus 2010;23:506-511. https://doi.org/10.1111/j.1442-2050.2009.01040.x
  17. Sikkema M, Kerkhof M, Steyerberg EW, et al. Aneuploidy and overexpression of Ki67 and p53 as markers for neoplastic progression in Barrett's esophagus: a case-control study. Am J Gastroenterol 2009;104:2673-2680. https://doi.org/10.1038/ajg.2009.437
  18. Meijssen MA, Tilanus HW, van Blankenstein M, Hop WC, Ong GL. Achalasia complicated by oesophageal squamous cell carcinoma: a prospective study in 195 patients. Gut 1992;33:155-158. https://doi.org/10.1136/gut.33.2.155
  19. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164-188.
  20. Raymond L, Lach B, Shamji FM. Inflammatory aetiology of primary oesophageal achalasia: an immunohistochemical and ultrastructural study of Auerbach's plexus. Histopathology 1999;35:445-453. https://doi.org/10.1046/j.1365-2559.1999.035005445.x
  21. Sherr CJ. Cancer cell cycles. Science 1996;274:1672-1677. https://doi.org/10.1126/science.274.5293.1672
  22. Boller D, Spieler P, Schoenegg R, et al. Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma. Surg Endosc 2009;23:2748-2754. https://doi.org/10.1007/s00464-009-0489-0

피인용 문헌

  1. Retention Esophagitis in Patients with Achalasia Requires Cancer Surveillance vol.51, pp.2, 2018, https://doi.org/10.5946/ce.2018.037
  2. Histopathological Analysis of Esophageal Mucosa in Patients with Achalasia vol.15, pp.5, 2021, https://doi.org/10.5009/gnl20195