GI Surgery Annual

272 Pages·2019·6.187 MB·English

by  T.K. Chattopadhyay, Peush Sahni, Sujoy Pal

GI Surgery Annual
Series Editor: T. K. Chattopadhyay
Peush Sahni
Sujoy Pal Editors
GI Surgery
Annual
Volume 25
Indian Association of
Surgical Gastroenterology
GI Surgery Annual
Series Editor
T. K. Chattopadhyay
Department of HPB Surgery
Institute of Liver and Biliary Sciences
New Delhi, India
This compendium of reviews in gastrointestinal surgery covers topics that are of
contemporary interest to surgeons reflecting the popular trends in this field. Started
by the Indian Association of Surgical Gastroenterology (IASG), the GI Surgery
Annual has covered a journey of over 2 decades which speaks for its relevance and
popularity among general and gastrointestinal surgeons. The reviews contain up-to-
date scientific content of enduring academic interest with each new volume covering
10-12 topics. From 2016 onwards, this Annual turns a new page in its academic
journey by publishing the forthcoming titles with Springer. The editorial control
continues to remain with the IASG and the current editorial board.
The Idea of GI Surgery Annual was first conceived during the annual conference
of Indian Association of Surgical Gastroenterology in 1991 and the First Volume
came into existence in the year 1994, through the efforts of Professor TK
Chattopadhyay and his team of co-editors. Professor TK Chattopadhyay continues
to head the editorial board in his current capacity as Professor Emeritus, AIIMS,
New Delhi.
This Annual is an essential resource for postgraduate and postdoctoral trainees in
surgery and gastrointestinal surgery, for practising surgeons who wish to keep
up-to-date with developments in the field and for established academic surgeons as
well.
More information about this series at http://www.springer.com/series/15222
T. K. Chattopadhyay
Editor-in-Chief
Peush Sahni • Sujoy Pal
Editors
GI Surgery Annual
Volume 25
Editor-in-Chief
T. K. Chattopadhyay
Department of HPB Surgery
Institute of Liver and Biliary Sciences
New Delhi, India
Editors
Peush Sahni Sujoy Pal
Department of GI Surgery and Liver Department of GI Surgery and Liver
Transplantation Transplantation
All India Institute of Medical Sciences All India Institute of Medical Sciences
New Delhi, India New Delhi, India
ISSN 2367-3435 ISSN 2367-3443 (electronic)
GI Surgery Annual
ISBN 978-981-13-3226-5 ISBN 978-981-13-3227-2 (eBook)
https://doi.org/10.1007/978-981-13-3227-2
© Indian Association of Surgical Gastroenterology 2019
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Preface
It is indeed a pleasure to bring to you the twenty-fifth volume of the GI Surgery
Annual. During its journey, the Annual has been quite popular among members of
the association. I, as the editor, have enjoyed producing each issue over these years.
It has been a very satisfying effort.
Advances in surgical gastroenterology have been so great that the Indian
Association of Surgical Gastroenterology had decided to disseminate this infor-
mation among its members through the GI Surgery Annual. In the early years of
its existence, the Association had a fair number of its members living in far flung
areas of the country who did not have ready access to the available literature.
Mind you, this was before the days of the internet! Things have changed and
indeed remarkably. What has not changed is the desire to acquire new knowledge
for better patient care.
I and my co-editors are committed to further this cause.
Happy reading!
New Delhi, India T. K. Chattopadhyay

v
Contents
1 Esophagogastric Junction (EGJ) Carcinoma: An Updated Review . . . 1
Rajneesh Kumar Singh
2 Superior Mesenteric Artery Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . 63
V. P. Bhalla, V. K. P. Singh, R. Vats, and D. Goel
3 Biologics and Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . 91
V. Pratap Mouli and Vineet Ahuja
4 New Surgical Modalities in the Management of Rectal Cancer . . . . . . 121
Deeksha Kapoor, Amanjeet Singh, and Adarsh Chaudhary
5 Tumor Markers in GI and HPB Cancers . . . . . . . . . . . . . . . . . . . . . . . . 139
Anand Bharathan and V. Sitaram
6 IgG4 HPB Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Jimil Shah and Usha Dutta
7 ERCP-Induced Perforations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
S. Soundappan, R. Pradeep, G. V. Rao, and D. N. Reddy
8 Bridging Therapy for HCC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Shailesh Sable and Vinay Kumaran
9 Adjuncts to Liver Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Ragini Kilambi and Senthil Kumar
10 Advances in Gastrointestinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
T. K. Chattopadhyay
vii
About the Editors
T. K. Chattopadhyay is Professor Emeritus in the Department of GI Surgery and

Liver Transplantation, All India Institute of Medical Sciences, New Delhi. He initi-
ated this series 25 years ago and has been the Editor-in-Chief of this series since its
inception. Presently, he is Professor and Head of the Department of HPB Surgery,
Institute of Liver and Biliary Sciences, New Delhi.
Peush Sahni is Professor and Head of the Department of GI Surgery and Liver

Transplantation, All India Institute of Medical Sciences, New Delhi. He has been
Editor since the second volume of this series.
Sujoy Pal is Professor in the Department of GI Surgery and Liver Transplantation,

All India Institute of Medical Sciences, New Delhi. He has been Editor of this series
since 2005.
ix
Chapter 1
Esophagogastric Junction (EGJ)
Carcinoma: An Updated Review
Rajneesh Kumar Singh
1.1 Introduction
Epithelial carcinomas constitute the majority of all cases of esophageal cancer.
While squamous cell carcinoma (SCC) typically occurs throughout the esophagus
(commonest middle third), adenocarcinomas mostly occur in the distal one-third
and the esophagogastric junction (EGJ). All adenocarcinomas involving the EGJ are
included under the group of EGJ carcinomas; these include esophageal carcinomas,
gastric carcinomas and true carcinomas of the cardia. It is rare for lower esophageal
SCCs to involve the EGJ; hence all discussion of EGJ carcinomas refers to adeno-
carcinoma. The incidence of adenocarcinoma has increased, while that of SCC has
declined steadily in the Western population, in the last few decades [1, 2]. Hence
EGJ carcinoma has become a tumour of increasing importance over the last few
decades. The reasons for the increasing focus on these tumours include the rising
incidence in the Western world, the controversies in classifications, the generally
poor prognosis and major differences in the treatment and outcomes as compared to
squamous cell carcinoma of the esophagus.
The other aspect in which esophageal adenocarcinomas differ from SCC is the
well-characterized metaplasia-dysplasia-carcinoma sequence for which a large
volume of scientific research has accumulated from across the world. This provides
an opportunity to study the molecular mechanisms of carcinogenesis and early
diagnosis and treatment of some of these tumours [3].
Adding to complexity in case of EGJ adenocarcinoma are the multiple termi-
nologies used by different authors to denote one or all subgroups of EGJ carcinoma,
varying from ‘junctional’ carcinoma, ‘cardia’ tumours, gastro-esophageal junction
R. K. Singh (*)
Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGIMS), Lucknow, UP, India
© Indian Association of Surgical Gastroenterology 2019 1
P. Sahni, S. Pal (eds.), GI Surgery Annual, GI Surgery Annual,
https://doi.org/10.1007/978-981-13-3227-2_1
2 R. K. Singh
tumours, distal esophageal adenocarcinoma, etc. One often needs have a careful
look at the patient cohort represented while interpreting studies including these
tumours.
1.2 Classification
As opposed to the usual organ-based neoplasias, EGJ carcinomas are a heteroge-
neous group of zone-based tumours that arise from or involve the gastro-esophageal
junction; these include esophageal, gastric and true cardia carcinomas. The hetero-
geneity in this group pertains to the epidemiology, etiopathogenesis, molecular
pathology, differences in treatment and outcomes of the different subgroups. These
within group differences in clinical behaviour were understood quite early, and sev-
eral attempts were made to subclassify these tumours. Most of these classifications
are topographical classifications, and the most commonly referred to is the one pro-
vided by Professor Siewert and his group. In the 1990s this classification was
adopted by a consensus conference of the International Gastric Cancer Association
and the International Society for Diseases of the Esophagus, and experts concluded
that this should form the basis of definition, investigation and reporting management
of EGJ adenocarcinoma [4].
EGJ carcinomas were defined by Siewert as a group of epithelial carcinomas
arising from a zone 5 cm below or 5 cm above the EGJ and mandatorily involving
the EGJ [5]. This needs an accurate definition of the location of the EGJ, consider-
ing the fact that anatomists, physiologists and endoscopists have all defined the EGJ
differently [6]. Adding to this confusion is the shifting of the squamocolumnar junc-
tion due to columnar metaplasia of the lower esophagus, at least in some patients.
The best accepted definition of EGJ for this purpose is that it lies at the proximal
limit of the gastric mucosal folds (rugae). Siewert divided these into three subgroups
based on the epicentre of the tumour [5]:
• Type 1 tumours: Distal esophageal adenocarcinoma infiltrating the EGJ and
mostly associated with intestinal metaplasia, i.e. Barrett’s esophagus (epicentre
located more between 1 and 5 cm above the EGJ).
• Type 2 tumours: True carcinoma of the cardia arising from the epithelium of the
gastro-esophageal junction and often referred to as ‘junctional carcinoma’
(epicentre located between 1 cm above to 2 cm below the EGJ).
• Type 3 tumours: Subcardiac gastric carcinoma located below the EGJ and infil-
trating the gastro-esophageal junction and distal esophagus (epicentre located
between 2 and 5 cm below the EGJ).
The Siewert classification was based on data from their large experience. The
salient features separating the three types of tumours are as in Tables 1.1 and
1.2. Siewert type 1 adenocarcinoma is quite similar to esophageal adenocarci-
noma, including a male preponderance, a strong history of reflux disease and
mainly intestinal- type (Lauren) histology. The majority of these tumours are