PS01.001: CARCINOMA IN ESOPHAGEAL ACHALASIA: WHO, WHEN AND HOW. (14th September 2018)

• Record Type: Journal Article
• Authors: Vinicius, ; Mazzini, Guilherme; Felipe Juchem, José; Gurski, Richard
• Is Part Of: Diseases of the esophagus. Volume 31(2018)Supplement 1
• Page Start: 49
• Page End: 49
• Publication Date: 2018-09-14
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doy089.PS01.001
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: Esophageal achalasia is a precancerous condition for epidermoid carcinoma; prevalence and risk factors for cancer development are not defined. Aim of the study was to determine these parameters. Methods: Achalasia patients observed in the period 1955-2016, since 1973 were periodically submitted to clinical assessment, barium swallow (esophageal diameter and residual barium column were measured), endoscopy, according to a prospective protocol. In this study we included patients with a minimum 12 months follow-up, endoscopy or radiology at the last control. Follow up was discontinued for decision or death of patients. Results: Five hundred and eighty-three of 681 cases were considered. The median follow-up was 147.13 months (IQR 70.42-257.82 months); 17 epidermoid, 1 carcinosarcoma were diagnosed (30.8/1000 cases). At multivariate analysis esophageal diameter (p < 0.001), residual barium column (p < 0.05) and duration of dysphagia (p < 0.001) were independent risk factors. Conversely, the risk of epidermoid carcinoma development decreased after residual barium swallow decrease (p < 0.05), consequent to efficacious therapy. According to classification tree (Figure), patients with severe dysphagia at the last clinical-radiological control and sigmoid esophagus experienced a risk of epidermoid carcinoma development equal to 48.6%. classification tree for squamous cell carcinoma. o outcome; se sigmoid esophagus.jpg Conclusion: End-stage achalasia and dysphagia lasting longer than 22 years are risk factors for development of epidermoid cancer. Effective Heller myotomy can interrupt the carcinogenetic process in the presence of end-stage achalasia. Patients who overcome the risk parameters, should be offered esophagectomy or conservative surgery followed by strict endoscopic surveillance. Disclosure: All authors have declared no conflicts of interest.