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We read the article with great interest by Sato et al. [1] This article provided some suggestions for the surveillance endoscopy for risk factors for achalasia-related esophageal cancers (ECs). We appreciate the hard work of the authors, and we have some suggestions for the surveillance endoscopy in achalasia.
Achalasia is a primary esophageal motility disorder, and it has been reported to be associated with ECs. However, details of achalasia-related ECs are not well investigated since achalasia is a rare disease with unknown etiology.
Although the relative risk of ECs in achalasia patients is considered higher, the absolute risk is still low with the incidence of EC about 0.59 per 100 person-year [2]. Therefore, many guidelines reported insufficient evidence to support routine screening in achalasia patients [3, 4]. But several researches found that several population may need endoscopy screening. This article by Sato H et al. pointed that endoscopic surveillance is important in patients with a long history of achalasia, advanced age (more than 40 years), male sex, and regular alcohol intake [1]. Sato et al. also found that organized surveillance may be considered in cases with a history of ECs and the risk factors, such as long disease duration, advanced age, regular alcohol consumption, and smoking. [5] Both of the two studies were not detected Barret adenocarcinoma. Zagari revealed that risk factors included male sex, with long-standing disease, and patients with Barrett’s esophagus (BE) may be need endoscopic surveillance [2]. The European Society of Gastrointestinal Endoscopy recommends screening in high-risk groups as follows: achalasia, with chronic gastroesophageal reflux disease (GERD) greater than five years, age of 50 years, male sex, and a first-degree relative with BE or esophageal adenocarcinoma [6].
Therefore, based on the current evidence, we suggest routine endoscopic surveillance for ECs in achalasia patients in high-risk factors, including male sex, 40 years of age, with a long history of achalasia symptoms onset over 10 years, BE, with chronic GERD, and regular alcohol intake and smoking.
ReferencesSato H, Terai S, Shimamura Y, et al. Achalasia and esophageal cancer: a large database analysis in Japan. J Gastroenterol. 2021;56:360–70.
Zagari RM, Marasco G, Tassi V, et al. Risk of squamous cell carcinoma and adenocarcinoma of the esophagus in patients with achalasia: a long-term prospective cohort study in Italy. Am J Gastroenterol. 2021;116:289–95.
Khashab MA, Vela MF, Thosani N, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91:213-27.e6.
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115:1393–411.
Sato H, Nishikawa Y, Abe H, et al. Esophageal carcinoma in achalasia patients managed with endoscopic submucosal dissection and peroral endoscopic myotomy: Japan Achalasia Multicenter Study. Dig Endosc. 2022;34:965–73.
Săftoiu A, Hassan C, Areia M, et al. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2020;52:293–304.
Author informationAuthors and AffiliationsAuthorsHuifang XiaYan PengXiaowei TangCorresponding authorAdditional informationPublisher's NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Cite this articleXia, H., Peng, Y. & Tang, X. Is it necessary for endoscopic surveillance for achalasia patients?. J Gastroenterol (2022). https://doi.org/10.1007/s00535-022-01916-1
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