Virtual Educational Channel
OESO and the OESO-SEMPIRE Platform of Excellence in Esophagology
continue to be a trail blazer
in all fields of Esophagology.
A new model of Education has come forward
with the OESO-SEMPIRE Virtual Educational Channel.
Indeed, going beyond the traditional series of presentations one after the other,
the clinical case of a patient becomes the focal point of interest: it becomes
the starting point of a two hour intense educational interaction between top experts,
punctuated by comments and questions by a worldwide floor.
Details on program and time will be announced on the OESO website and in the next Newsletter.
From the Hospital das Clínicas
São Paulo University Medical School, Brazil
Hosted by Prof. Bruno Zilberstein
Professor of Surgery
Wednesday, June 23, 2021
South America: São Paulo, 10 am – 12 noon
- Europe: Paris, 3 – 5 pm
- North America: West Coast: 6 am / East Coast: 9 – 11 am
- Africa: Bomet, Kenya, 4 – 6 pm
- Asia: Beijing, 9 – 11 pm
- Australia: Melbourne, 11 pm – 1 am (June 24, 2021)
High grade dysplasia
A 65 year old, white male patient.
- Heartburn and regurgitations for 20 years
- No dysphagia, no respiratory symptoms
- Regular use of PPI – 60 m Dexalanzoprazol for the last 3 years
- No weight loss. (BMI = 25 Kg/m2)
2 cm hiatal hernia
C4M6 Barrett’s esophagus (Prague classification)
Nodular area with microvascular patterns alterations
- Biopsies: High grade dysplasia in Barrett’s epithelium
- CT scan and Echo-endoscopy: no remarkable findings
- ESD / resection of the lesion and 60% of the columnar epithelium.
- Histology: moderately differentiated adenocarcinoma (T1a)
Invasion till the mucosa
Lateral and deep margins free of adenocarcinoma
- Follow-up endoscopy 3 months after ESD:
3 cm hiatal hérnia (Type I)
Ulcer in distal esophagus on the previous site of ESD
Recurrent columnar epithelium in distal esophagus
- Biopsies: Barrett’s epithelium with intestinal metaplasia without dysplasia
Surveillance endoscopy planned for 2 months, with biopsies/Seattle protocol,
and RFA ablation of the Barrett epithelium.
Due to COVID 19 pandemic, the patient returned to our department
only after 14 months, complaining of mild dysphagia.
Elevated lesion on the anterior wall of distal esophagus. Biopsies (A)
Ulcer-infiltrative lesion at the right posterolateral wall of the distal esophagus. Biopsies (B)
3 cm hiatal hernia (Type I).
A: Invasive, moderately differentiated adenocarcinoma at the squamous-columnar junction
B: Poorly differentiated carcinoma at the squamous-columnar junction with intestinal metaplasia and high grade dysplasia in the adjacent columnar mucosa
- PET-CT scan: 2-3cm lesion at the GEJ (SUV max 11,2).
No suspicious lymph nodal invasion.
- Subtotal esophagectomy with lymphadenectomy and gastric pull-up.
- Histology: poorly differentiated adenocarcinoma at the squamo-columnar junction with intestinal metaplasia and high grade dysplasia in the adjacent columnar mucosa (pT3pN2M0).
- Postoperative chemotherapy
- 6 months after surgery, disease-free patient without any complication.
Presentation of the case:
- Prof. Bruno Zilberstein (FMUSP – Brazil)
- Dr Sergio Szachnowicz (FMUSP– Brazil)
- Diagnosis and management of long Barrett’s esophagus with HGD
- Endoscopic treatment of early adenocarcinoma
- Surveillance after endoscopic treatment of Barrett’s adenocarcinoma
- Siewert type I adenocarcinoma: staging, treatment options, and best practices.
Discussion led by Bruno Zilberstein with a top level panel currently being assembled.
Panel for discussion:
- Italo Braghetto, Santiago de Chile
- Ivan Cecconello, São Paulo
- John Clarke, Stanford
- Yeong Yeh (Justin) Lee, Kuala Lumpur
- Eduardo GH Moura, São Paulo
- Matthew Read, Melbourne
- Rubens AA Sallum, São Paulo
- Andrew Taylor, Melbourne
- David Wang, Dallas
- Yinglian Xiao, Guangzhou
Registration is free, but mandatory.