Dietary Patterns and Severity of Symptom with the Risk of Esophageal Squamous Cell Carcinoma and its Histological Precursor Lesions in China: A Multicenter Cross-Sectional Latent Class Analysis

Background: Dietary patterns and symptoms research among Chinese with esophageal squamous cell carcinoma (ESCC) and its precursor lesions is limited, especially as it relates to multiple food consumption and multiple co-occurring symptoms. The aim of our study was to identify the dietary patterns and severity of symptom classes with the risk of esophageal squamous cell carcinoma and its histological precursor lesions, and develop a risk prediction model for different stages of esophageal disease.Methods: We analyzed data from a multicenter cross-sectional study carried out in ESCC high incidence areas between 2017 and 2018, which included 34,707 individuals aged 40-69 years. Dietary patterns and severity of symptom classes were derived by applying a latent class analysis (LCA). A multiple logistic regression model was used to derive the odds ratio (ORs) and corresponding 95% confidence intervals (CIs) for ESCC and the different stages of esophageal disease according to the dietary patterns and severity of symptom classes identified. We built the risk prediction model by using a nomogram.Results: We identified five dietary patterns and three severity of symptom classes. The dietary patterns were classified as follows: “Healthy”, “Western”, “Lower consumers-combination”, “Medium consumers-combination” and “Higher consumers-combination” patterns based on the intake of foods such as red meat, vegetables and fruits. The severity of symptoms was categorized into “Asymptomatic”, “Mild symptoms” and “Overt symptoms” classes based on health-related symptoms reported by the participants. Compared to the “Healthy” pattern, the other four patterns were all associated with an increased risk of esophageal disease. Similarly, the other two symptom classes present different degrees of increased risk of esophageal disease compared to the “Asymptomatic”. The nomograms reflect the good predictive ability of the model.Conclusion: Among individuals aged 40-69 years in high incidence regions of upper gastrointestinal cancer, the results supplied important epidemiological evidence and given further insights into dietary patterns and symptoms research.

Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation

Purpose The development of an atrio-esophageal fistula, a rare yet potentially lethal complication of ablation for atrial fibrillation, could be related to direct tissue heat transfer during and immediately after the ablation. We therefore studied the postoperative esophageal findings by esophagogastroduodenoscopy in patients that underwent a hybrid ablation procedure using a novel preventive strategy to avoid thermal lesions. Methods Thirty-four patients (28 males; 65 years ± 9 years) were retrospectively included. All underwent a hybrid ablation in our center between April 2015 and November 2019 and agreed to an esophagogastroduodenoscopy within 0–14 days (mean: 5 days) following the ablation. To reduce the incidence of thermal lesions three procedural preventive strategies were introduced: (i) videoscopic intrathoracic transesophageal echocardiographic probe visualization to understand the relationship between posterior left atrial wall and esophagus, with probe retraction before ablation; (ii) lifting the cardiac tissue away from the esophagus during energy application; and (iii) a 30-s cool-off period after energy delivery with irrigation of the device, the ablated tissue, and the surrounding tissues. Results No esophageal thermal lesions were observed. One third of patients were diagnosed with incidental esophageal findings unrelated to the ablation procedure (11; 32.4%). Conclusion Novel preventive strategies by visualization and by avoiding contact between the ablation catheter or ablated tissue and the pericardium, seems to eliminate the potential risk of esophageal thermal lesions in the setting of hybrid ablation. Since one third of patients had preexisting esophageal disease, a more comprehensive pre-operative screening could be important to reduce the risk.

Discovery and validation of methylation signatures in circulating cell-free DNA for early detection of esophageal cancer: a case-control study

Background Plasma cell-free DNA (cfDNA) methylation has shown promising results in the early detection of multiple cancers recently. Here, we conducted a study to investigate the performance of cfDNA methylation in the early detection of esophageal cancer (ESCA). Methods Specific methylation markers for ESCA were identified and optimized based on esophageal tumor and paired adjacent tissues (n = 24). Age-matched participants with ESCA (n = 85), benign esophageal diseases (n = 10), and healthy controls (n = 125) were randomized into the training and test sets to develop a classifier to differentiate ESCA from healthy controls and benign esophageal disease. The classifier was further validated in an independent plasma cohort of ESCA patients (n = 83) and healthy controls (n = 98). Results In total, 921 differentially methylated regions (DMRs) between tumor and adjacent tissues were identified. The early detection classifier based on those DMRs was first developed and tested in plasma samples, discriminating ESCA patients from benign and healthy controls with a sensitivity of 76.2% (60.5–87.9%) and a specificity of 94.1% (85.7–98.4%) in the test set. The performance of the classifier was consistent irrespective of sex, age, and pathological diagnosis (P > 0.05). In the independent plasma validation cohort, similar performance was observed with a sensitivity of 74.7% (64.0–83.6%) and a specificity of 95.9% (89.9–98.9%). Sensitivity for stage 0–II was 58.8% (44.2–72.4%). Conclusion We demonstrated that the cfDNA methylation patterns could distinguish ESCAs from healthy individuals and benign esophageal diseases with promising sensitivity and specificity. Further prospective evaluation of the classifier in the early detection of ESCAs in high-risk individuals is warranted.

804 THE PATTERN OF CT RECURRENCE FOLLOWING RESECTION OF ESOPHAGEAL CARCINOMA

While esophagectomy is the mainstay of multimodal treatment of esophageal cancer, the risk of recurrence is high. In spite of this, no formal recommendations exist on frequency or duration of computed tomography (CT) imaging for surveillance. The goal of this study was to determine the pattern of cancer recurrence following esophagectomy to develop an optimal surveillance program. Methods We performed a retrospective review of a single-institution esophageal disease registry, evaluating patients who underwent esophagectomy for esophageal cancer between 2000–2019. The surveillance protocol is CT in 3-month intervals for one year, 6-month intervals in year 2, then annually until the fifth year. Rates of recurrence were compared by stage, tumor factors, and chemoradiation status using chi-square tests. Monthly rates of recurrence and overall survival were assessed using Kaplan–Meier. Risk ratios for recurrence were evaluated with multivariate Cox regression accounting for age, gender, cancer type, stage, chemoradiation therapy, and tumor grade. Results Of the 368 included, 88% had Adenocarcinoma, 85% male, 96% Caucasian, 85% received chemotherapy, and 82% received radiation. 24% had pathologic complete response (pCR). The recurrence rate was 33%. 46% had clinical symptoms at time of recurrence, and 58% were diagnosed by routine surveillance CT. 21% of pCR had recurrence. 85% of recurrences occurred within 5 years, 72% within 3 years, and 56% within 2 years of surgery. Most frequent recurrence was lung (22%), followed by multi-site (21%), and regional lymph node (17%). There were notable differences in time to recurrence by site of recurrence (Figure 1) (p = 0.03). Conclusion In our population, 33% of patients had recurrence of esophageal cancer following surgical resection, with highest risk of recurrence within the first 3 postoperative years. These findings favor more frequent surveillance during this period, followed by annual surveillance until 5 years.

10 EFFECT OF SUBSPECIALTIES OF GASTRO-INTESTINAL SURGERIES ON PATIENT’S OUTCOMES

Subspecialty policy is increasing all over the world aiming to improve the results of heavy esophageal surgeries. Our aim is to define the impact of having surgical specialized esophageal unit on the volume of patients and the results. Methods We reviewed all esophageal cases managed in our esophageal specialized department (from May 2016 to May 2019 Group A) and we compared the results to previous 3 years (from May 2013 to May 2016 Group B) and to the international results. There was 394 cases in group A compared to 104 cases in group B. Results For Gastro esophageal reflux disease (GERD),180 operations were performed in group a (45.7%) compared to 61 cases in group B (68.7%). Forty two (10.7%) modified Heller’s cardiomyotomy (Open and laparoscopic) for achalasia were performed in group A compared to 17 cases (16.3%) in group B. Surgeries for malignant lesions were performed for 122 cases (30.9%) in group A compared to 13 cases (12.5%) in group B. Other Esophageal operations were also done for 50 cases (12.7%) in group A compared to 13 cases (12.5%) in group B. Morbidities and mortalities are reported and compared to the international results. Conclusion Our results in group A are comparable to Hospital mortality rates for patients in medium-volume centers (7.5%). Also we approach the International results for morbidities of benign esophageal disease (5.7–12.7%) for fundoplication. Having a specialized esophageal unit resulted in increase of the volume of patients and improvement of the results.

Oligometastatic Adenocarcinoma of the Esophagus: Current Understanding, Diagnosis, and Therapeutic Strategies

Esophageal adenocarcinoma is an aggressive cancer of increasing incidence and is associated with poor prognosis. The early recognition of synchronous and metachronous oligometastasis in esophageal adenocarcinoma may allow for prompt intervention and potentially improved survival. However, curative approaches to oligometastatic esophageal disease remain unproven and may represent an area of emerging divergence of opinion for surgical and medical oncologists. We sought to identify the current understanding and evidence for management of oligometastatic esophageal adenocarcinoma by performing a thorough review of the available literature.

Histopathological Evaluation of Endoscopic Esophageal Biopsies

Background: Esophageal lesions have a wide range of clinical and pathologic spectrum. Understanding the endoscopic and pathologic features of esophageal lesions is critical for detecting, differentiating, and managing them. Esophageal lesions incidence might be neoplastic or non-neoplastic. Aim: The current study aims to assess the clinical, endoscopic and histopathological evaluation of Esophageal Lesions. Materials and Methods: The current cross-sectional study was conducted on 102 esophageal lesions received at the Pathology Department of Gulab Devi Chest Hospital, Lahore for the period during June 2020 to May 2021. Endoscopy was used to obtain esophageal biopsies of either gender, regardless of their age. Each case was microscopically evaluated, and biopsy specimens were immediately secured in 10% buffered neutral formalin. Data analysis and collection was done in SPSS version 21. Results: Out of 102 endoscopic esophageal biopsies referred to Pathology Department for histopathological evaluation,male and female prevalence were 68 (66.7%) and 34 (33.3%) respectively. The overall mean age was 53.24±6.73 with an age range from 21 to 80 years. Based on age, the patient’s biopsies were categorized into six groups. A higher prevalence of esophageal lesions was observed in 51-60 (36.3%) years followed by age group 61-70 years (23.5%). Of the 102 patient’s biopsies,66 (64.7%) biopsy revealed squamous cell carcinoma, squamous dysplasia cases were 12 (11.8%), squamous papilloma was seen in one (0.98%) case, Adenocarcinoma cases were 4 (3.9%), Barrett’s esophagus was 4 (3.9%), esophagitis was 11 (10.8%) and squamous epithelium only was present in 4 (3.9%) cases. Conclusion: Esophageal cancer is the common digestive tract malignancy. Malignancy can be distinguished from non-neoplastic masses on endoscopy by their symptoms, appearanceand size. For an early esophageal disease diagnosis, endoscopy is a popular and developed inspection means which can identify Barrett’s esophagus and squamous dysplasia from malignant lesions,which can help in proper treatment and follow-up. Microscopic evaluation of lesions labeled as inflammatory on endoscopy can turn out to be malignant. This demonstrates the importance of microscopic examination as a confirmatory diagnostic tool. Accurate diagnosis can be carried out on microscopic examination with immunohistochemistry and histochemical stains. Keywords: Esophagus; Epithelial lesions; Sub-epithelial lesions; Endoscopy