Endoscopic and histologic characterization of esophagogastric neojunction after esophagectomy

In the last decades the incidence of gastro-esophageal junction’s (GEJ) adenocarcinoma has increased dramatically in Western countries. Therefore, the etiopathogenesis and natural history of GEJ pathological processes’ has been subject of extensive research. The definition of cardia is a controversial topic - the nature, location, extent and even the existence of cardiac mucosa is under discussion. Some authors argue that cardia is a native structure (congenital), present from birth; others, favor a metaplastic phenomenon secondary to gastroesophageal reflux. Regardless cardia’s nature, cardiac mucosa can be identified in other locations where its nature is clearly metaplastic: esophagus (in Barrett's esophagus/CLES – columnar lined esophageal segments) and anastomosis after esophagectomy. The esophagectomy with proximal gastric resection and esofagogastrostomy ("gastric pull-up") seems to be the ideal model to study gastric reflux effect on the remaining esophagus and metaplasia development. The presence of cardiac type mucosa in the anastomosis corroborates its acquired nature, instead of a congenital origin. We purpose to develop a prospective, observational, single-center study to evaluate/ characterize endoscopic and histologically the gastro-esophageal neo-junction of patients undergoing esophagectomy with upper polar gastrectomy and "gastric pull-up". We aim to ascertain the possible development of the cardiac type epithelium, reproducing, "in vivo" the natural history of cardiac mucosa. Patients included will perform high definition upper GI endoscopy, and biopsy protocol, at 3, 6 and 12 months, until the columnar epithelium is identified. Additionally, we will evaluate the degree of inflammation, the Helicobacter pylori status and the phenotypic profile of metaplastic columnar epithelium. Patients will also be assessed for the presence of gastroesophageal reflux symptoms.