title: Barrett's esophagus (BE) and carcinoma in the esophageal stump (ES) after esophagectomy with gastric pull-up in achalasia patients: a study based on 10 years follow-up.
abstract: BACKGROUND
  Subtotal esophagectomy and gastric pull-up with cervical anastomosis is the main treatment for advanced achalasia. This surgical technique has been associated to esophagitis and also Barrett's epithelium following esophagectomy.
  
  
  OBJECTIVE
  To analyze late clinical, endoscopic, and pathologic findings in the esophageal stump (ES) mucosa after subtotal esophagectomy in patients treated for advanced chagasic achalasia.
  
  
  METHODS
  101 patients submitted to esophagectomy and cervical gastroplasty were followed-up prospectively for a mean of 10.5 +/- 8.8 years. All patients underwent clinical, endoscopic and histopathological evaluation every 2 years. Gastric acid secretion was also assessed.
  
  
  RESULTS
  The incidence of esophagitis in the esophageal stump (45.9% at 1 year; 71.9% at 5 years, and 70.0% at 10 years follow-up); gastritis in the transposed stomach (20.4% at 1 year, 31.0% at 5 years, and 40.0% at 10 or more years follow-up), and the occurrence of ectopic columnar metaplasia and Barrett's Esophagus in the ES (none until 1 year; 10.9% between 1 and 5 years; 29.5% between 5 and 10 years; and 57.5% at 10 or more years follow-up), all rose over time. Gastric acid secretion returns to its preoperative values 4 years postoperatively. Esophageal stump cancer was detected in the setting of chronic esophagitis in five patients: three squamous cell carcinomas and two adenocarcinomas.
  
  
  CONCLUSIONS
  (1) Esophagitis and Barrett's esophagus in the esophageal stump rose over time. (2) These mucosal alterations and the development of squamous cell carcinoma and adenocarcinoma are probably due to exposure to duodenogastric reflux, and progressively higher acid output in the transposed stomach.
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, Rua Oscar Freire, 1546 Apto 171, 05409-010, São Paulo, SP, Brazil, jrmarian@terra.com.br
authors.forename: Julio Rafael Mariano
authors.initials: JR
authors.lastname: da Rocha
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.forename: Rubens A A
authors.initials: RA
authors.lastname: Sallum
authors.forename: Sérgio
authors.initials: S
authors.lastname: Szachnowicz
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004383:Duodenogastric Reflux / Q000150:complications / Q000473:pathology / Q000601:surgery; D004931:Esophageal Achalasia / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy; D004941:Esophagitis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000601:surgery; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies