Introduction

Esophageal cancer is the seventh most common type of cancer and sixth leading cause of cancer-related deaths worldwide. Dumping syndrome is a common type of postoperative complications in esophageal cancer patients.

Aims & Methods

This systematic review aimed to assess the prevalence of dumping syndrome after surgery in esophageal cancer patients. A comprehensive literature search was conducted in PubMed, MEDLINE, Web of Science, Embase and the Cochrane Library databases, supplemented by hand-search of reference lists, through March 2023. Random-effects meta-analysis estimated the average prevalence of dumping syndrome after esophageal cancer surgery by study design. Heterogeneity across studies was examined by the I² statistic and Cochran’s Q test.

Results

A total of 2949 articles were retrieved from the database, among which 17 articles (7 cohort studies, 9 case-series and 1 randomized controlled trial) met the inclusion criteria. The prevalence of dumping syndrome ranged 6%-74% in cohort studies, and meta-analysis estimated the pooled prevalence of 37% (95 confidence interval [CI] 14%-65%; I²=98%, P for heterogeneity <0.01). The prevalence of dumping syndrome reported in case-series ranged and meta-analysis estimated the pooled prevalence of 18% (95% CI 7%-34%; I²=98%, P for heterogeneity <0.01). The randomized controlled study involving 300 patients reported no occurrence of dumping syndrome.

Conclusion

The prevalence of dumping syndrome after esophageal cancer surgery differed greatly as reported in previous studies, which might be explained by differences in definition and assessment of dumping syndrome, length of follow-up and patients’ characteristics. Standardized methods in measuring dumping syndrome are needed in future investigations.

Disclosure

None

Introduction

When esophageal cancer is diagnosed at an advanced stage, it requires a highly invasive treatment, and its prognosis is poor. Although the number of endoscopic examinations has been increasing globally, esophageal cancer is still difficult to diagnose at an early stage. The rapidly increasing number of endoscopic examinations performed over a short period might influence diagnostic performance. Accessing the association between calendar month and esophageal cancer detection rates might improve policy and guide institutional support.

Aims & Methods

We aimed to evaluate the association between the increased number of examinations over a certain period and esophageal cancer detection rates (EDR) among a large population in the Korean National Cancer Screening Program (KNCSP). We performed a retrospective population-based study using the KNCSP database for gastric cancer between 2015 and 2019. We included 28,032,590 Koreans aged ≥40 years. We assessed monthly EDR and performed a negative binomial regression model and least square mean evaluation to evaluate the association between the screening month and EDR.

Results

In total, 28,032,590 subjects underwent upper endoscopy, according to KNCSP. The monthly number of subjects who underwent examinations was the highest in December (n=4,819,606, 17.2%). EDR tended to decrease towards the end of the year, and EDR was the lowest in December 2015 – 2019 (0.06 – 0.08). In the multivariable logistic model, the association of calendar month with detected cancer remained after adjusting for other confounding factors (December 2015: odds ratio, 0.58; 95% CI, 0.43 – 0.79; P < .001; 2016: odds ratio, 0.51; 95%CI, 0.38 – 0.67; P < .001). The age group adjusted the calendar month, and the predicted detection rate significantly decreased at the end of the year compared with the beginning of the year in 2015, 2016, and 2017 respectively.

Conclusion

In the KNCSP, the workload of endoscopists increased excessively, with an increasing number of examinations towards the end of the year, as demonstrated by decreased EDR during this period.

Introduction

Esophageal cancer is known to be a strongly male dominant disease. However, the gender differences have not been well understood. We aimed to evaluate the differences between male and female esophageal cancer in Korean population.

Aims & Methods

We retrospectively analyzed patients confirmed as esophageal cancer in Asan Medical Center between January 2005 and December 2015. The clinical features of patients, histopathologic characteristics of tumor, treatment response, and survival were investigated between male and female patients respectively.

Results

A total of 2,068 patients were analyzed. The median age was younger in female (62 years; interquartile range [IQR] 38-85) than male (64 years, IQR 37–90), and the male to female ratio was 13.4:1. Squamous cell carcinoma was major pathologic type (99.0% in male and 93.1% in female), however, the proportion of adenocarcinoma was higher in female than male (5.6% vs. 0.8%, p<0.001). Female patients smoked less (22.2% vs. 86.5%, p<0.001) and drank less alcohol (26.4% vs 89.9%, p<0.001) than male patients. Female had upper and middle esophagus dominant tumor location (75.0%), whereas middle and lower dominant in male (81.7%). Multivariate analysis showed that gender (Hazard ratio [HR], 0.77; 95% CI, 0.60 to 0.99; p=0.044), age (HR, 1.03; 95% CI, 1.02 to 1.03; p<0.001), and advanced tumor stage (stage 4, HR, 14.3; 95% CI, 8.43 to 24.4; p<0.001) were independent prognostic factors for overall survival. The 5-year overall survival rate of female was higher than those of male (53.5% vs. 44.5%, p=0.038). Cancer recurrence rate in complete remission patients were significantly lower in female than male (15.3% vs. 25.1%, p=0.03).

Conclusion

The gender is an independent prognostic factor for esophageal cancer, with favorable survival outcomes in female than male. Further research is warranted to determine the cause of prognostic difference in esophageal cancer in male and female.

Disclosure

There is no conflict of interest.

Clinical Case Summary

A 65-year old man visited our hospital for abdominal pain. Esophagogastroduodenoscopy showed an area of fainted redness in the right upper thoracic esophagus. Narrow band imaging (NBI) detected a demarcated area with brownish dots. Intrapapillary capillary loops (IPCL) implied that the carcinoma had not invaded the deep submucosa. The entire lesion showed no stains by 1% Lugol’s iodine solution. Therefore, endoscopic submucosal dissection (ESD) was conducted under general anesthesia with endotracheal intubation. Labeling, submucosal injection, mucosal incision were performed according to surgical protocols. During dissection, however, a depression was observed in the left of the cancer lesion. Submucosal and muscular defects appeared in the depression edge, which indicated a shallow pulsion diverticulum under the lesion. We proceeded cautiously the dissection to separate the submucosa from the adventitia. ESD was successfully completed without perforation. To prevent postoperative perforation, we placed a covered esophageal stent. Post-ESD CT showed mild mediastinal emphysema. No other adverse events were observed and the patient was discharged at five days after ESD. The esophageal stent was removed at one month after ESD without perforation, stenosis or bleeding. Histopathological examination showed a well-differentiated squamous cell carcinoma within the mucosa without lympho-vascular invasion, suggesting a low risk of recurrence without additional treatment. Esophageal cancer that involves diverticula is extremely rare. The thin wall of diverticulum is easily to be perforated, bringing a great challenge to endoscopic resection. The location of an esophageal diverticulum in the cancer lesion is critical to its outcome.In conclusion, we reported a rare case of a superficial esophageal cancer with an esophageal diverticulum, which was invisible before the ESD. The cancer was successfully removed by ESD with no perforation.

References

1. Watanabe S, Matsuda, K. Arima K, et.al. Detection of subclinical disorders of the hypopharynx and larynx by gastrointestinal endoscopy. Endoscopy. 1996; 28(3): 295-298.
2. Herbella, Fernando A M et al. Are idiopathic and Chagasic achalasia two different diseases? Digestive diseases and sciences vol. 49,3 (2004): 353-60.
3. Shinwa, T, Takashi T, Yoshiko O, et al. Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer. World J Gastroenterol. 2015 March 14;21(10):3121-3126.

Disclosure

All authors declare that there is no conflict of interest.

Introduction

Plummer-Vinson syndrome is a rare entity that associates dysphagia, iron deficiency anemia, and cervical esophageal membrane. Our work aimed to describe the clinical profile and to specify the predictive factors of degeneration in patients with Plummer-Vinson syndrome associated with esophageal cancer and to show interest in endoscopic surveillance.

Aims & Methods

It was a retrospective descriptive and analytical study over 30 years (1993-2023) including all patients treated and followed up for Plummer-Vinson syndrome and who presented esophageal cancer. Data collection and statistical analysis were performed by SPSS version 20.0 software.

Results

Out of the 160 patients treated for Plummer-Vinson syndrome, 15 patients had associated esophageal cancer resulting in a prevalence of 9.37%. The median age was 50.6 years with extremes of 28 and 74 years, with a sex ratio of M/F = 2/13. The interval between the diagnosis of Plummer-Vinson syndrome and the appearance of cancer was 8 years +/- 7.4.
All our patients with associated cancer had dysphagia with weight loss, odynophagia in 92.9% (n=13), clinical anemia syndrome in 59 %(n=8), and upper gastrointestinal bleeding in 10%(n=1). All patients had hypoferritinemia with a median value of ferritin 6.2μg/l.
The location of the Plummer-Vinson ring was at the level of the Killian triangle at 46%(n=7) and the upper third of the esophagus at 54%(n=8).
The location of the cancerous process at the level of Killian's triangle was in 46% of cases (n=7), and the location at the level of the upper third of the esophagus was in 19.7%(n=3). In 33.3% of cases (n=5) in the middle third. It was squamous cell carcinoma in all cases. Surgical treatment was initiated in 14% of cases (n=2), radio-chemotherapy in 72% (n=11) and refusal of treatment in 14% of cases (n=2). Two patients progressed well with the disappearance of dysphagia, 10 patients died between 5 months and 5 years of cancer progression, and the rest of the patients could not be followed up.
In multivariate analysis, the statistically significant predictive factors for the degeneration of Plummer-Vinson syndrome were: Age>50.6 years (OR= 2.37, p=0.003 CI=1.875-4.236), Ferritinemia <6.2 μg/l (OR=3.02, p=0.001 CI=0.977-12. 516) and location of the ring at the level of the Killian triangle (OR=1.140, p=0.001 CI=1.057-1.229). Gender and dysphagia did not appear to be associated with degeneration with (p=0.26) and (p=0.35) respectively.

Conclusion

Plummer-Vinson syndrome is a precancerous lesion requiring endoscopic surveillance. In our series, the prevalence was 9.37%. Malignant transformation of this ring at the level of the triangle of Killian was present in 46% of cases. The predictive factors of degeneration were advanced age, low ferritinemia, and the location of the ring in the mouth of Killian.