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 This work is subject to copyright. All rights in this edition are solely and exclusively licensed by Springer Nature Singapore Pte Ltd., whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore 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