THE OESO-SEMPIRE

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.

 

*

11th meeting:

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)

 

​

 

Barrett esophagus

High grade dysplasia

 

A 65 year old, white male patient.

Non smoker

 

• 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)

 

Diagnosis process:

• Endoscopy:
  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

 

Therapeutic process:

• 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.

 

• Endoscopy:
  No stenosis
  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).
• Biopsies:
  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).

 

Uneventful follow-up:

• 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)

 

Discussion points:

• 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.

 

​Free registration

 

The next 12th Clinical case coming up for discussion on September 2021.

Details on program and time will be announced on the OESO website and in the next Newsletter.

 

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ANNOUNCEMENT

In the framework of its cooperation with the New York Academy of Sciences, OESO is pleased to announce to the international scientific community the publication (Wiley Publ.) of the 15th and 16th volumes of its Encyclopedia of Esophagology.

 

These two books, which follow the 15th OESO World Congress in Beijing, contain 39 Review Articles in two consecutive special issues of the Annals of the New York Academy of Sciences.

 

These 39 papers, like the congress they follow, cover topics related to the various disciplines represented in OESO, and each of them is the result of the work of teams of international specialists of the highest level in their fields.