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Endoscopy
Original research
Possible tumour cell reimplantation during curative endoscopic therapy of superficial Barrett’s carcinoma
  1. Hanno Ehlken1,
  2. Rüdiger Schmitz1,
  3. Sabine Riethdorf2,
  4. Lutz Riethdorf3,
  5. Jenny Krause4,
  6. Karl-Frederick Karstens5,
  7. Jörg Schrader4,
  8. Fabrice Viol4,
  9. Anastasios Giannou4,
  10. William Sterlacci6,
  11. Michael Vieth6,
  12. Till Clauditz7,
  13. Christian Kähler7,
  14. Oliver Mann5,
  15. Jakob R Izbicki5,
  16. Samuel Huber4,
  17. Klaus Pantel2,
  18. Thomas Rösch1
  1. 1 Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  3. 3 Pathology Practice Grandweg, Hamburg, Germany
  4. 4 Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  5. 5 Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  6. 6 Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
  7. 7 Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Thomas Rösch, Interdisciplinary Endoscopy, University Hospital Hamburg Eppendorf Center of Diagnostic, Hamburg 20246, Germany; t.roesch{at}uke.de

Abstract

Background and aims Endoscopic resection has been established as curative therapy for superficial cancer arising from Barrett’s oesophagus (BE); recurrences are very rare. Based on a case series with unusual and massive early recurrences, we analyse the issue of tumour cell reimplantation.

Methods This hypothesis was developed on the basis of two out of seven patients treated by circumferential (n=6) or nearly circumferential (n=1) en bloc and R0 endoscopic resection of T1 neoplastic BE. Subsequently, a prospective histocytological analysis of endoscope channels and accessories was performed in 2 phases (cytohistological analysis; test for cell viability) in 22 different oesophageal carcinoma patients undergoing endoscopy. Finally, cultures from two oesophageal adenocarcinoma cell lines were incubated with different triamcinolone concentrations (0.625–10 mg/mL); cell growth was determined on a Multiwell plate reader.

Results Cancer regrowth in the two suspicious cases (male, 78/71 years) occurred 7 and 1 months, respectively, after curative tumour resection. Subsequent surgery showed advanced tumours (T2) with lymph node metastases; one patient died. On cytohistological examinations of channels and accessories, suspicious/neoplastic cells were found in 4/10 superficial and in all 5 advanced cancers. Further analyses in seven further advanced adenocarcinoma cases showed viable cells in two channel washing specimens. Finally, cell culture experiments demonstrated enhanced tumour cell growth by triamcinolone after 24 hours compared with controls.

Conclusions Tumour cell reimplanation from contaminated endoscopes and accessories is a possible cause of local recurrence after curative endoscopic therapy for superficial Barrett carcinoma; also, corticosteroid injection could have promoted tumour regrowth in these cases.

  • adenocarcinoma
  • Barrett's carcinoma
  • Barrett's oesophagus
  • endoscopy

Data availability statement

Data are available upon reasonable request. All data on patients and experiments are available at the UKE Hamburg Germany.

https://doi.org/10.1136/gutjnl-2020-322723

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    Data availability statement

    Data are available upon reasonable request. All data on patients and experiments are available at the UKE Hamburg Germany.

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    Footnotes

    • Contributors The case histories were compiled by HE, RS, JK, TC and TR. The endoscope and accessory examinations were performed and analysed by HE, SR, LR, JK, WS, MV, TC, CK and KP. The tumor cell culture experiments were performed and analysed by K-FK, JS, FV and AG. Data analysis was done by TR with support from RS, SR, LR and JK. Manuscript writing was one by TR with input from all coauthors. All authors had access to the study data and had reviewed and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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