Overview
Gastroesophageal erosion refers to damage or ulceration of the esophageal or gastroesophageal junction lining, often associated with underlying conditions such as cancer, inflammation, or adverse drug reactions. 13Diagnosis
Endoscopic Evaluation: Essential for visualizing erosions and assessing extent. 456
Biopsy: Recommended when malignancy or specific histological subtypes are suspected to guide treatment. 3
Imaging Studies: May be necessary for staging and assessing complications, particularly in cancer patients. 1
Laboratory Investigations: Useful for monitoring systemic effects and guiding management in specific contexts. 3Management
Targeted Therapies:
- HER2-negative Gastric/Esophageal Adenocarcinoma: Nivolumab with chemotherapy for PD-L1 CPS ≥ 5; pembrolizumab with chemotherapy for PD-L1 CPS ≥ 10. 1
- Esophageal Squamous Cell Carcinoma: Nivolumab plus chemotherapy or nivolumab plus ipilimumab for PD-L1 ≥ 1%; pembrolizumab plus chemotherapy for PD-L1 ≥ 10%. 1
FGFR2b Inhibitors: Bemarituzumab for FGFR2b-high gastroesophageal adenocarcinoma. 2
Endoscopic Management: For symptomatic relief and healing, including endoscopic therapy and stenting in cases of strictures or obstruction. 3Special Populations
Elderly Patients: Intensive surveillance strategies may vary; tailored approaches based on comorbidities and functional status are recommended. 3
Comorbidities: Management should consider interactions and impact on overall health status, particularly in cancer patients receiving targeted therapies. 13Key Recommendations
For HER2-negative gastroesophageal adenocarcinoma with PD-L1 CPS ≥ 5, first-line therapy with nivolumab and chemotherapy is recommended. (Evidence: Strong 1)
In patients with esophageal squamous cell carcinoma and PD-L1 ≥ 1%, consider nivolumab plus chemotherapy or nivolumab plus ipilimumab. (Evidence: Strong 1)
Intensive surveillance strategies should be individualized based on patient characteristics and lesion location, with imaging and endoscopic procedures more common in distal esophageal lesions. (Evidence: Moderate 3)
Use of unsedated transnasal endoscopy can be a viable alternative to conventional sedated endoscopy, improving patient tolerance and reducing complications, particularly in appropriate patient populations. (Evidence: Moderate 456)References
1 Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB et al.. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2023. link
2 . Bemarituzumab Is Active in FGFR2b-High Gastroesophageal Adenocarcinoma. Cancer discovery 2020. link
3 Peixoto RD, Lim HJ, Kim H, Abdullah A, Cheung WY. Patterns of surveillance following curative intent therapy for gastroesophageal cancer. Journal of gastrointestinal cancer 2014. link
4 Stroppa I, Grasso E, Paoluzi OA, Razzini C, Tosti C, Andrei F et al.. Unsedated transnasal versus transoral sedated upper gastrointestinal endoscopy: a one-series prospective study on safety and patient acceptability. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2008. link
5 Thota PN, Zuccaro G, Vargo JJ, Conwell DL, Dumot JA, Xu M. A randomized prospective trial comparing unsedated esophagoscopy via transnasal and transoral routes using a 4-mm video endoscope with conventional endoscopy with sedation. Endoscopy 2005. link
6 Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD. Endoscopy 2003. link