Clinical Endoscopy

Factors influencing lateral margin diagnosis challenges in Barrett’s esophageal cancer: a bicenter retrospective study in Japan: Ippei Tanaka, Shuhei Unno, Kazuki Yamamoto, Yoshitaka Nawata, Kimihiro Igarashi, Tomoki Matsuda, Dai Hirasawa; Received March 28, 2024 Accepted June 4, 2024 Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.068 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation.
Methods
We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE).
Results
We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively).
Conclusions
LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

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Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer: Iatagan R. Josino, Bruno C. Martins, Andressa A. Machado, Gustavo R. de A. Lima, Martin A. C. Cordero, Amanda A. M. Pombo, Rubens A. A. Sallum, Ulysses Ribeiro Jr, Todd H. Baron, Fauze Maluf-Filho; Clin Endosc 2023;56(6):761-768. Published online July 25, 2023; DOI: https://doi.org/10.5946/ce.2022.297

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
Methods
This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
Results
Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival.
Conclusions
The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

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Clinical Implications of Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma: Cancer-Draining Blood Versus Peripheral Blood
Dong Chan Joo, Gwang Ha Kim, Hoseok I, Su Jin Park, Moon Won Lee, Bong Eun Lee
Cancers.2024; 16(16): 2921. CrossRef
How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
Kwang Bum Cho
Clinical Endoscopy.2023; 56(6): 735. CrossRef

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Management of esophageal neoplasms by endoscopic submucosal dissection: experience over 100 consecutive procedures: Josué Aliaga Ramos, Yoshinori Morita, Takashi Toyonaga, Danilo Carvalho, Moises Salgado Pedrosa, Vitor N. Arantes; Clin Endosc 2023;56(5):613-622. Published online May 17, 2023; DOI: https://doi.org/10.5946/ce.2022.245

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases.
Methods
This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality.
Results
Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months.
Conclusions
ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.

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Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center: Andreas Probst, Alanna Ebigbo, Stefan Eser, Carola Fleischmann, Tina Schaller, Bruno Märkl, Stefan Schiele, Bernd Geissler, Gernot Müller, Helmut Messmann; Clin Endosc 2023;56(1):55-64. Published online January 13, 2023; DOI: https://doi.org/10.5946/ce.2022.093

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center.
Methods
Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database.
Results
R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038).
Conclusions
Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

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Endoscopic submucosal dissection for early esophageal squamous cell carcinoma: long-term results from a Western cohort
Ilse N. Beaufort, Charlotte N. Frederiks, Anouk Overwater, Lodewijk A.A. Brosens, Arjun D. Koch, Roos E. Pouw, Jacques J.G.H.M. Bergman, Bas L.A.M. Weusten
Endoscopy.2024; 56(05): 325. CrossRef
Long-Term Outcomes of Esophageal Squamous Neoplasia with Muscularis Mucosa Involvement after Endoscopic Submucosal Dissection
Chen-Huan Yu, Yueh-Hung Chou, Tze-Yu Shieh, Chao-Yu Liu, Jiann-Ming Wu, Chen-Hsi Hsieh, Tzong-Hsi Lee, Chen-Shuan Chung
Biomedicines.2024; 12(8): 1660. CrossRef
Endoscopic Submucosal Dissection for Esophageal Cancer: Current and Future
Yuki Okubo, Ryu Ishihara
Life.2023; 13(4): 892. CrossRef

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Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer: Atsushi Goto, Takeshi Okamoto, Ryo Ogawa, Kouichi Hamabe, Shinichi Hashimoto, Jun Nishikawa, Taro Takami; Clin Endosc 2022;55(4):520-524. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.262

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Background
/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods
Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results
Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions
Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).

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Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application
Qing-Xia Wang, Yuan Ding, Qi-Liu Qian, Yin-Nan Zhu, Rui-Hua Shi
World Journal of Gastrointestinal Endoscopy.2024; 16(9): 509. CrossRef
Development of applicator to deliver hydrogel precursor powder for esophageal stricture prevention after endoscopic submucosal dissection
Takeshi Fujiyabu, Pan Qi, Kenichi Yoshie, Ayano Fujisawa, Yosuke Tsuji, Arvind Kumar Singh Chandel, Athira Sreedevi Madhavikutty, Natsuko F. Inagaki, Seiichi Ohta, Mitsuhiro Fujishiro, Taichi Ito
Chemical Engineering Journal.2024; 500: 156742. CrossRef

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Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia: Koichi Hamada, Koichiro Kawano, Atsushi Yamauchi, Ryota Koyanagi, Yoshinori Horikawa, Shinya Nishida, Yoshiki Shiwa, Noriyuki Nishino, Michitaka Honda; Clin Endosc 2019;52(3):252-257. Published online May 23, 2019; DOI: https://doi.org/10.5946/ce.2018.151

Abstract PDF PubReader ePub

Background
/Aims: Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection (ESD) is currently insufficient. This study aims to evaluate the efficacy and safety of esophageal ESD under GA.
Methods
A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japanese institutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS) were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively.
Results
There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumor size was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), procedure time was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm2 /min vs. 16.2 [2.4–41.3] mm2 /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group, but the difference did not achieve statistical significance (p=0.242 and p=0.242).
Conclusions
GA shortens the procedure time of esophageal ESD.

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Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended
Atsushi Goto, Koichi Hamabe, Shunsuke Ito, Shinichi Hashimoto, Jun Nishikawa, Taro Takami
Esophagus.2025; 22(1): 85. CrossRef
General Anesthesia and Endoscopic Upper Gastrointestinal Tumor Resection
Seung Hyun Kim
Journal of Digestive Cancer Research.2023; 11(3): 125. CrossRef
Endoscopic resection of esophageal squamous cell carcinoma: Current indications and treatment outcomes
Seiichiro Abe, Yuichiro Hirai, Takeshi Uozumi, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Yutaka Saito
DEN Open.2022;[Epub] CrossRef
Subtotal esophageal endoscopic submucosal dissection for long-segment Barrett’s esophagus and adenocarcinoma
Dai Kubota, Yoshiki Sakaguchi, Sayaka Nagao, Yosuke Tsuji, Mitsuhiro Fujishiro
Endoscopy.2022; 54(10): E583. CrossRef
Translation from manual to automatic endoscopic insufflation enhanced by a pressure limiter
Yuki Ushimaru, Tsuyoshi Takahashi, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Kazuyoshi Yamamoto, Tomoki Makino, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, Kiyokazu Nakajima
Surgical Endoscopy.2022; 36(9): 7038. CrossRef
Gel immersion endoscopic submucosal dissection: clinical experience with 13 cases of superficial esophageal cancer
Yuya Nakano, Tomoaki Tashima, Ryuhei Jinushi, Rie Terada, Yumi Mashimo, Tomonori Kawasaki, Toshio Uraoka, Shomei Ryozawa
Endoscopy International Open.2022; 10(09): E1302. CrossRef
Computer-aided diagnosis of esophageal cancer and neoplasms in endoscopic images: a systematic review and meta-analysis of diagnostic test accuracy
Chang Seok Bang, Jae Jun Lee, Gwang Ho Baik
Gastrointestinal Endoscopy.2021; 93(5): 1006. CrossRef
Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection
Keiichi Ashikari, Takashi Nonaka, Takuma Higurashi, Tomohiro Takatsu, Tsutomu Yoshihara, Noboru Misawa, Jun Arimoto, Kenji Kanoshima, Tetsuya Matsuura, Akiko Fuyuki, Hidenori Ohkubo, Hideyuki Chiba, Atsushi Nakajima
Journal of Gastroenterology and Hepatology.2021; 36(7): 1920. CrossRef
Bilateral tension pneumothorax during endoscopic submucosal dissection under general anesthesia diagnosed by point-of-care ultrasound - A case report -
Seok Kyeong Oh, Seung Inn Cho, Young Ju Won, Jin Hee Yun
Anesthesia and Pain Medicine.2021; 16(2): 171. CrossRef
Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia
Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki
Clinical Endoscopy.2021; 54(6): 916. CrossRef
Feasibility of the lidocaine injection method during esophageal endoscopic submucosal dissection
Tetsuya Yoshizaki, Daisuke Obata, Chise Ueda, Norio Katayama, Yasuhiro Aoki, Norihiro Okamoto, Hiroki Hashimura, Masanori Matsumoto, Megumi Takagi, Seitaro Ikeoka, Ryutaro Yoshida, Kenji Momose, Takaaki Eguchi, Hiroshi Yamashita, Akihiko Okada
JGH Open.2020; 4(2): 251. CrossRef
Commentary on “Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia”
Soo In Choi, Jun Chul Park
Clinical Endoscopy.2019; 52(3): 205. CrossRef

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Endoscopic Submucosal Dissection Followed by Concurrent Chemoradiotherapy in Patients with Early Esophageal Cancer with a High Risk of Lymph Node Metastasis: Hee Kyung Kim, Weon Jin Ko, Chang-Il Kwon, Ga Won Song, In Kyun Yoo, Ji Hyun Song, Hak Su Kim, Joo Young Cho; Clin Endosc 2019;52(5):502-505. Published online May 14, 2019; DOI: https://doi.org/10.5946/ce.2018.176

Abstract PDF PubReader ePub

Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.

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Unveiling Therapeutic Targets for Esophageal Cancer: A Comprehensive Review
Rakesh Acharya, Ananya Mahapatra, Henu Kumar Verma, L. V. K. S. Bhaskar
Current Oncology.2023; 30(11): 9542. CrossRef
Editorial “Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer”
Rian M. Hasson, Joseph D. Phillips
Annals of Surgical Oncology.2019; 26(9): 2662. CrossRef

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New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining: Masato Tsunoda, Yoshimasa Miura, Hiroyuki Osawa, Tsevelnorov Khurelbaatar, Mio Sakaguchi, Hisashi Fukuda, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2019;52(5):497-501. Published online April 16, 2019; DOI: https://doi.org/10.5946/ce.2018.195

Abstract PDF PubReader ePub

A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o’clock position inside the iodineunstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o’clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.

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Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasia
Cesare Hassan, Giulio Antonelli, Philip Wai‐yan Chiu, Fabian Emura, Kenichi Goda, Prasad G. Iyer, Sameer Al Awadhi, Abed Al Lehibi, Vitor Arantes, Cecilio L. Cerisoli, Peter Draganov, David Fleischer, Fernando Fluxá, Nicolas Gonzalez, Haruhiro Inoue, Sneh
Digestive Endoscopy.2024;[Epub] CrossRef
Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study
Zi-Xin Wang, Long-Song Li, Song Su, Jin-Ping Li, Bo Zhang, Nan-Jun Wang, Sheng-Zhen Liu, Sha-Sha Wang, Shuai Zhang, Ya-Wei Bi, Fei Gao, Qun Shao, Ning Xu, Bo-Zong Shao, Yi Yao, Fang Liu, En-Qiang Linghu, Ning-Li Chai
World Journal of Gastroenterology.2023; 29(12): 1899. CrossRef
Usefulness of linked color imaging in the early detection of superficial esophageal squamous cell carcinomas
Koki Nakamura, Yuji Urabe, Shiro Oka, Naoko Nagasaki, Naoki Yorita, Kosaku Hata, Kazuhiko Masuda, Mio Kurihara, Takahiro Kotachi, Tomoyuki Boda, Shinji Tanaka, Kazuaki Chayama
Esophagus.2021; 18(1): 118. CrossRef
Inter‐observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging
Sang Pyo Lee, Sea Hyub Kae, Hyun Joo Jang, Dong Hee Koh, Eun Suk Jung
Journal of Digestive Diseases.2021; 22(7): 425. CrossRef

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A Case of Early Esophageal Cancer Treated by Photodynamic Therapy in a Patient with Liver Cirrhosis Accompanied by Esophageal Varix: Yoon Yung Chung, M.D., Woo Chul Chung, M.D., U-Im Chang, M.D., Ju Hyun Oak, M.D., Yeon Oh Jeong, M.D., Min Ju Kim, M.D., Chang Nyol Paik, M.D. and Kang-Moon Lee, M.D.; Korean J Gastrointest Endosc 2010;41(5):298-302. Published online November 30, 2010

Abstract PDF: Photodynamic therapy (PDT) is a non-invasive treatment for cancer that works through a photochemical effect after the administration of a photosensitizer. At first, PDT had been used for the relief of obstructive symptoms caused by exophytic esophageal cancer or for control of tumor overgrowth. Recently, several investigators have reported the use of PDT in early esophageal cancer with encouraging results. This report describes a case of a 52-year-old man with early esophageal cancer, who had a long history of liver cirrhosis with esophageal varix. The patient was treated successfully with PDT using porfimer sodium as the photosensitizer. PDT is an alternative to surgical treatment of early esophageal cancer, especially in patients with liver cirrhosis. (Korean J Gastrointest Endosc 2010;41:298-302)

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Three Cases of Double Primary Cancer in the Esophagus and Stomach: Hye Suk Son, M.D., Jin Soo Kim, M.D., Young Seok Cho, M.D., Hyung Keun Kim, M.D., Jeong Yo Min, M.D., Myong Ki Baeg, M.D., Yun Ji Kim, M.D. and Hiun Suk Chae, M.D.; Korean J Gastrointest Endosc 2009;38(1):28-33. Published online January 30, 2009

Abstract PDF: Double primary cancer means that more than 2 cancers occur independently in an individual. There have been many reports on double primary cancer since Billroth reported it for the first time in 1889 and Warren and Gates established it. The incidence of esophageal cancer is low, about 1~2% of all cancer and, 7% of all gastrointestinal cancer, but double cancer with including esophageal cancer is 9.5~27% of all double primary cancer. Double primary cancer of the esophagus and stomach has occasionally been reported. We have experienced three cases of double primary cancer of squamous carcinoma in the esophagus and adenocarcinoma in the stomach. In this study we reviewed the clinical characteristics of the reported cases of double primary esophageal and gastric cancer that have been reported in Korea and these three cases we experienced at our hospital. (Korean J Gastrointest Endosc 2009;38:28-33)

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A Case of Double Primary Cancer of the Esophagus and Duodenum that Induced Hematemesis: Young Ho Kim, M.D., Chan Hee Seo, M.D. and Moo Yeol Lee, M.D.; Korean J Gastrointest Endosc 2008;37(6):413-418. Published online December 30, 2008

Abstract PDF: The occurrence of double primary cancer of the esophagus and duodenum is considered to be very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency towards early metastasis. Yet the development of endoscopy such as endoscopic ultrasonography (EUS), the new diagnostic imaging modalities such as PET/CT and advanced pathologic interpretation can lead to an early diagnosis of these multiple primary neoplasms. Appropriate intervention with various therapeutic tools then becomes possible, so these multiple primary neoplasms are not currently obstinate problems. We experienced one patient with double primary cancer; we simultaneously found esophageal cancer and duodenal cancer via endoscopy, and we wanted to treat them with chemo- radiation therapy and endoscopic submucosal dissection, but we failed to persuade the patient to accept the treatment. (Korean J Gastrointest Endosc 2008;37:413-418)

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A Case of Double Primary Cancer that Occurred Continuously at the Esophagogastric Junction: Hyeok Jin Kwon, M.D., Chang Woo You, M.D., Sang Kyoon Kim, M.D., Hye Jin Jeong, M.D., Seung Hun Kim, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D.,Soo Teik Lee, M.D. and Dae Ghon Kim, M.D.; Korean J Gastrointest Endosc 2007;34(1):33-37. Published online January 30, 2007

Abstract PDF: The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.

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A Case of Photodynamic Therapy as a Curative Treatment of Early Esophageal Cancer: Chang Nyol Paik, M.D., Myung Gyu Choi, M.D., Kye Weol Kim, M.D., In Seok Lee, M.D., Jung Hwan Oh, M.D., Jae Myung Park, M.D., Joon Wook Lee, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;33(1):37-41. Published online July 30, 2006

Abstract PDF: Although the surgical treatment of early esophageal cancer is a well-known curative modality, less invasive endoscopic methods have attracted significant attention recently on account of the fewer postoperative complications, better quality of life and preservation of the integrity of the esophagus. Among the various endoscopic techniques employed, photodynamic therapy (PDT) has been used to allow the selective destruction of malignant tissue through a photochemical effect after the administration of a photosensitizer for curative and palliative treatment purposes. This report describes a case of a 73-year-old man with early esophageal cancer, which had been diagnosed by fluorodeoxyglucose-positron emission tomography (FDG-PET) and endoscopy and a long history of chronic pulmonary diseases such as emphysema and radiation fibrosis. The patient was cured successfully with photodynamic therapy using porfimer sodium as the photosensitizer. (Korean J Gastrointest Endosc 2006;33: 37⁣41)

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Photodynamic Therapy for Superficial Gastrointestinal Tumors: Young Koog Cheon, M.D., Dae Hee Han, M.D., In Seop Jung, M.D., Chang Beom Ryu, M.D., Joo Young Cho, M.D., Yun Soo Kim, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2006;32(2):81-86. Published online February 27, 2006

Abstract PDF: Background
/Aims: Although photodynamic therapy (PDT) has been used for the endoscopic treatment of digestive cancer, its curative efficacy remains uncertain. This study evaluated the curative role of PDT in superficial gastrointestinal cancer. Methods: Fifteen lesions in 14 patients with a histologically proven carcinoma (early esophageal cancer 6, early gastric cancer 8, ampulla of Vater cancer 1) were injected with an intravenous hematoporphyrin derivative (2 mg/kg), and PDT was performed 48 hours later. The response to treatment was assessed by gastroscopy with biopsies. Results: The median follow-up time was 273 days (42∼1,030 days). According to the TNM stage of endoscopic ultrasonography, there were 14 T1 cases and 1 T2 case. Complete remission was observed in 13 cases after the initial and consecutive PDT. There were 2 cases of failure. The recurrence rate was 15.4% (2/13), and the median time from the initial PDT to recurrence was 349 days. Conclusions: PDT using a hematoporphyrin derivative as a photosensitizer is a safe and efficient method for treating early cancer. However, a long-term follow up period using a large population sample will be needed for confirmation. (Korean J Gastrointest Endosc 2006;32:81⁣86)

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A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer: Dong Kyun Son, M.D., Jae Kwang Kim, M.D., Ji Sung Chung, M.D., Don Hyoun Jo, M.D., Hyung Keun Kim, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Kyu Won Chung, M.D. and Hee Sik Sun, M.D.; Korean J Gastrointest Endosc 2004;29(1):13-16. Published online July 30, 2004

Abstract PDF: The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory. (Korean J Gastrointest Endosc 2004;29:13⁣16)

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상부 위장관 표재성종양에 대한 광역동 치료 효과: Korean J Gastrointest Endosc 2003;27(5):345-345. Published online November 20, 2003

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내장역위증에서 발견된 위암과 식도암이 병발된 중복암 1예 ( A Case of Double Cancer of the Esophagus and Stomach in Situs Inversus Totalis ): Korean J Gastrointest Endosc 1999;19(5):733-767. Published online November 30, 1998

Abstract PDF: Left-to-right transposition of the normally asymmetrical organs of the body is termed situs inversus. Situs inversus is a rare congenital anomaly; according to Varano and Merklin, the reported incidence is estimated at 1：5,000 to 10,000 in adults. Its etiology is obscure but it apparently does not influence normal health or life expectancy. Many cases of malignant neoplasms with situs inversus have been found in corresponding English literature, but there was no documentation of double cancer of the esophagus and stomach associated with situs inversus totalis. We present a case of double cancer of the esophagus and stomach in a 49-year-old male with situs inversus totalis. Chest X-rays and an abdominal CT scan revealed situs inversus totalis. A chest and abdominal CT scan, and gastroscopy with tissue biopsy determined esophageal and gastric cancer. (Korean J Gastrointest Endosc 19: 763∼767, 1999)

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식도암의 심달도 판정에 있어서 내시경적 초음파검사의 유용성 (Role and Limit of Endoscopic Ultrasonography in Staging for Esophageal Cancer ): Korean J Gastrointest Endosc 1999;19(2):178-185. Published online November 30, 1998

Abstract PDF: Background
Despite the technical developments in diagnosis and therapy, esophageal cancer is highly lethal disease and the survival is largely dependent upon the stage of the disease. Preoperative cancer staging is crucial in choosing a therapeutic option as well as in predicting the prognosis of the patients. Staging has been based on computerized tomography (CT) and transabdominal ultrasonography. However CT has a limit in pre-cisely discriminating the depth of invasion or the lymph node metastases. With the devel-opment of endoscopic ultrasonography (EUS) and with its superiority in delineating wall structure and detecting lymph node metastases, its usefulness in staging for esophageal cancer has been cknowledged. In order to evaluate the accuracy of EUS, we compared EUS with pathologic findings in patients with esophageal carcinoma. Methods: From July 1990 to August 1997, 136 patients with esophageal cancer received preoperative cancer staging with EUS. Among them, 48 patients who underwent surgical procedures with the intention of radical resection were included. We compared the EUS and pathologic find-ings and analysed the accuracy of EUS for preoperative staging. Results: The overall accu-racy of EUS for T-staging was 43.8%. Twenty five percents of the patients (12/48) pre-sented high-grade tumor strictures, which precluded the passage of the endoscope. There was no statistical significance according to tumor site, size or gross morphology. However theaccuracy was significantly lower in tumors with ulceration than in tumors without ulceration (35.3% vs 64.3%, p=0.004). Mainly, ulceration in tumors caused significant overstaging of the T-stage. In the assessment of regional lymph node metastasis, the overall accuracy achieved by EUS was 66.6%; the sensitivity was 95.5%, specificity 42.3%, positive predictive value 58.3%, and negative predictive value 91.7%. Tumors with more than 2 lymph nodes rendered more accurate N-staging than tumors with less than 2 lymph nodes. Conclusions: In conclusion, the accuracy of the EUS for preoperative staging of esophageal cancer was not satisfactory, mostly influenced by ulceration in tumors and its resultant inflammatory reactions around the tumors, therefore more systematic study will be needed to establish the precise diagnostic criteria of EUS staging. (Korean J Gastrointest Endosc 19: 178 ∼185, 1999)

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원저 : 식도 위장관 ; 식도암 조기 진단에 대한 색소내시경의 유용성 ( Original Articles : Esophagus , Stomach & Intestine ; Usefulness of Chromoscopy Using Lugol Solution for Detection of Superficial Esophageal Cancer ): Korean J Gastrointest Endosc 1996;16(6):921-927. Published online November 30, 1995

Abstract PDF: Background
/Aims: Esophageal cancer is not an uncommon cancer in Korea, however, the prognosis still remains very poor with a 5 year survival rate bemg less than l0% mainly becauae of the delayed diagnosis. Although chromoscopy with lugol solution has been received to diagnose the esophageal cancer in an early stage without difficulty, its clinical use has not been popular yet in Korea. This study was performed prospectively to evaluate the usefulness of the chromoscopy for the detection of superficial esophageal cancer in risk patients for esophageal cancer. Methods: Ninety-five patients were selected among persons who received gasiroscopy at Asan Medical Center between Jan. 1996 and May 1996 and were prospectively included for chromoscopy. Inclusion criteria for the chromoscopy were patients older than 60 years of age with smoking history of more than 30 packyears, and/or past or family history of cancers. After conventional endoscopic examination, lugol solution was sprayed to stain the glycogen granules in the epithelial cells. The size of unstained lesion was measured and stainability was classified into 5 grades. All lesions unstained were biopsied for histological diagnosis. (Korean J Gastrointest Endose 16: 821-927, 1996) (continue...)

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증례 : 식도 위장관 ; 인두로 전이된 식도암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Cancer with Metastasis to the Pharynx ): Korean J Gastrointest Endosc 1996;16(1):63-67. Published online November 30, 1995

Abstract PDF: Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures. (Kor J Gastrointest Endosc 16: 63~67, 1996)

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증례 : 식도 위장관 ; EEMR 튜브를 이용한 조기식도암의 근치적 절제 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Early Esophageal Cancer Treated by Endoscopic Mucosal Resection Using a EEMR Tube ): Korean J Gastrointest Endosc 1995;15(4):713-719. Published online November 30, 1994

Abstract PDF: Although esophageal cancer has been recognized as difficult to treat, its long-term survival statistics are significant lower than those of other gastrointestinal cancers, Postoperative 5-year survival of the early esophageal cancer which invasion is limited to the mucosa is close to 100%. So, early detection of esophageal cancer has been extremely significant. Progress in the endoscopic technique has enabled to make not only early detection but also curative endoscopic resection of the early esophageal cancers. The indication for curative endoscopic resection of esophageal cancer are as follows: mucosal cancer apart from gross invasion to the muscularis mucosae without nodal involvement and less than 2 cm * 2 cm in size of lesion. EEMR tube(endoscopic esophageal mucoaal resection tube), which was designed by Makuuchi in 1991, is widely used for resection of early esophageal cancers. We report a case of patient with early esophageal cancer, who was admitted due to complation of postprandial epigastric pain, diageosed by endoscopy, endoscopic ultra sonography and chest computerized tomography, and successfully resected by using EEMR tube. (Kar J Gastrointest Endosc 15: 713~ 718, 1995)

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증례 : 침윤성 흉선종에 속발한 조기식도암 1예 ( Case Reports : A Case of Early Esophageal Cancer Associated with Invasive Thymoma ): Korean J Gastrointest Endosc 1995;15(2):212-217. Published online November 30, 1994

Abstract PDF: Metachronous double cancer of primary early esophageal squamous cell carcinoma and invasive thymoma is a very rare condition. The invasive thymoma had been detected during the myathenia gravis evaluation and treated by radiation therapy 5 years ago. The esophageal lesion had a nodular-surfaced flat elevation at the mid-esophagus that was found by esophagoscopy. Radical resection for the lesions was undertaken after histologic confirmation. Postoperative pathologic examination documented that the esophageal squamous cell carcinoma was in the "early" stage involving the mucosal and submucosal layer only. We report a case of early esophageal cancer associated with invasive thyrnoma with literatures review.

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식도암의 병기결정에 있어서 내시경초음파검사의 유용성 : 예비보고 ( The Role of Endoscopic Ultrasonography in Staging of Esophageal Cancer : Preliminary Report ): Korean J Gastrointest Endosc 1993;13(3):539-543. Published online November 30, 1992

Abstract PDF: The prognosis of esophageal cancer is poor and strategies for treatment depend on the tumor stage at the time of diagnosis. Surgery is the main therapeutic modality in esophageal cancer and known as the only treatment for cure. Preoperatively it is most important to assess whether the primary tumor is completely resectable or not. Previous staging modality such as CT can not clearly define the depth of invasion and lymph node metastasis of esophageal cancer which is the most important factor in assessing the possibility of curative resection. Endoscopic ultrasonography is now considered as an useful method in evaluating staging and resectability of esophageal cancer. We compared the findings of endoscopic ultrasonography with pathology result to evaluate the accuracy of this new technique in staging of esophageal cancer in 4 esophageal cancer patients who received surgery among the 23 patients assessed by endoscopic ultrasonography due to esophageal cancer, The depth of invasion, lymph node metastasis, and staging was correct in 3 among 4 patients. We consider endoscopic ultrasonography is an useful technique in staging of esophageal cancer.

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식도 기관지 누공을 동반한 악성식도협착에서 Cuffed 인공식도관의 내시경적 삽관술 ( Endoscopic Treatment with a Cuffed Prosthesis for Malignant Esophago - Bronchial Fistula ): Korean J Gastrointest Endosc 1992;12(2):221-226. Published online November 30, 1991

Abstract PDF: Malignant esophago-bronchial fistula is an incurable and distressing condition. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coqghing and frequent pulmonary infection and collapse. Most patients are unfit for major surgery, but intubation offers a quick, simple and effective treatment with improved length and quality of life. However, intubation with simple esophageal tubes are liable to result in failure to occlude the fistela, migration of the tube, erosion, and in the case of latex tubes, disintegration. To overcome these problems, the fistula is intubated perorally with a prosthesis surrounded by a foam rubber cuff contained ia silicone sheath, in which vacuum can be created. This cuffed prosthesis is the most satisfactory design for the treatment of malignant esophago-bronchial fistula with effiective and gentle occlusion of the fistula without risk of pressure necrosis. We experienced a case of the endoscopic treatment with a cuffed prosthesis for malignant esophago-bronchial fistula. So we report this case with brief review of the previous literatures.

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역류성 식도염 및 식도 열공 허니아 ( Hiatal hernia ) 를 동반한 Schatzki 환 1예 ( A Case of Schatzki Ring of Esophagus Associated with Reflux Esophagitis and Hiatal Hernia ): Korean J Gastrointest Endosc 1991;11(2):235-239. Published online November 30, 1990

Abstract PDF: The Schatzki ring, a submucosal fibrotic thickening of the lower esophagus, occurs at the squamocolumnar junction and is invariably associated with an esophageal histal hernia The ring is discrete narrowing covered with squamous epithelium on its superior aspect and columnar epithelium on its inferior aspect, with various degrees of submucosal fibrosis supporting the annulair ring. Symptoms, when present, are generally those of distal esophageal obstruction to the passage of solids and highly associated with ring diameter. The pathogenesis and etlology are obscure. But one theory suggests that they are caused by gastroesophageal reflux. The vast maiority of symptomatic Schatzki rings sre ameneble to dilation, a few patients will require surgical antireflux measures after dilatation. We have experienced a case of Schatzki ring associated with reflux esophagitis and esophageal hiatal hernia by the esophagogram after barium swallowing and endoscopy. So we report this case with brief review of the previous literatures.

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미분화 소세포 성분이 포함된 식도암육종 1예 ( A Case Report of True Carcinosarcoma of the Esophagus , Which Contained Undifferentiated Small Cell Component ): Korean J Gastrointest Endosc 1991;11(2):231-234. Published online November 30, 1990

Abstract PDF: Carcinosarcoma of the esophagus is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. Esophageal carcinosarcoma classified into 3 subgroups, pseudosarcoma, so called carcinosarcoma, and true carcinosarcoma. we report a case of large polypoid tumor consist of squamous cell carcinoma, undifferentiatred small cell and spindle cell proliferation. The patient was 47 year-old man who had suffered from dysphasia and substernal chest pain for 2 months. A protruded tumor in size of 8x4x3.5 cm with stalk was found in midesophagus at the level of 28 cm from the incisor. The tumor was round with smooth surface stained with Lugol solution. There were multiple erosions at the stalk of the tumor, Partial esophagectomy and esophagogastrostomy was done, Undifferentiated small cell was confirmed by immunoreactivity to neuron specific enolase and electron microscopic findings.

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