Diseases of the Esophagus最新文献

{"title":"Western European Variation in the Organization of Esophageal Cancer Surgical Care","authors":"Maurits R Visser, Daan M Voeten, Suzanne S Gisbertz, Jelle P Ruurda, Michael P Achiam, Magnus Nilsson, Sheraz R Markar, Manuel Pera, Riccardo Rosati, Guillaume Piessen, Philippe Nafteux, Christian A Gutschow, Peter P Grimminger, Jari V Räsänen, John V Reynolds, Hans-Olaf Johannessen, Pedro Vieira, Michael Weitzendorfer, Aristotelis Kechagias, Mark I van Berge Henegouwen, Richard van Hillegersberg","doi":"10.1093/dote/doae033","DOIUrl":"https://doi.org/10.1093/dote/doae033","url":null,"abstract":"Reasons for structural and outcome differences in esophageal cancer surgery in Western Europe remain unclear. This questionnaire study aimed to identify differences in the organization of esophageal cancer surgical care in Western Europe. A cross-sectional international questionnaire study was conducted among upper gastrointestinal (GI) surgeons from Western Europe. One surgeon per country was selected based on scientific output and active membership in the European Society for Diseases of the Esophagus or (inter)national upper GI committee. The questionnaire consisted of 51 structured questions on the structural organization of esophageal cancer surgery, surgical training, and clinical audit processes. Between October 2021 and October 2022, 16 surgeons from 16 European countries participated in this study. In 5 countries (31%), a volume threshold was present ranging from 10 to 26 annual esophagectomies, in 7 (44%) care was centralized in designated centers, and in 4 (25%) no centralizing regulations were present. The number of centers performing esophageal cancer surgery per country differed from 4 to 400, representing 0.5–4.9 centers per million inhabitants. In 4 countries (25%), esophageal cancer surgery was part of general surgical training and 8 (50%) reported the availability of upper GI surgery fellowships. A national audit for upper GI surgery was present in 8 (50%) countries. If available, all countries use the audit to monitor the quality of care. Substantial differences exist in the organization and centralization of esophageal cancer surgical care in Western Europe. The exchange of experience in the organizational aspects of care could further improve the results of esophageal cancer surgical care in Europe.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"60 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140811020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic dysfunction-associated steatotic liver disease and risk of esophageal cancer in patients with diabetes mellitus: a nationwide cohort study","authors":"Yeong Jeong Jeon, Kyungdo Han, Seung Woo Lee, Ji Eun Lee, Junhee Park, In Young Cho, Jong Ho Cho, Dong Wook Shin","doi":"10.1093/dote/doae029","DOIUrl":"https://doi.org/10.1093/dote/doae029","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes and a developing several cancers including esophageal cancer (EC). However, the association between MASLD and EC in diabetic patients has not been investigated. Therefore, we aimed to investigate the relation between MASLD and developing EC in diabetic patients. This was a population-based retrospective cohort study of data from the Korean National Health Insurance Service (NHIS). A total of 1,904,468 subjects diagnosed with diabetes who underwent NHIS-provided health checkups from 2009 to 2012 were included. We constructed a Cox proportional hazard model for the association of fatty liver index (FLI) and the risk of EC stratified by potential confounders. Over a mean follow-up duration of 6.9 years, the incidence of EC was higher in the high (≥60) FLI group compared to the low (<30) FLI group (14.4 vs. 13.7 event per 100,000 person-years). The risk of EC correlated with the degree of FLI, particularly in older (P = 0.002), female (P = 0.033), non-smoking (P = 0.002), and non-drinking patients (P = 0.025). Among obese patients, the risk of EC was not associated with FLI; however, the risk of EC was higher in the high FLI group in non-obese patients. Lean MASLD patients had the highest risk of EC (adjusted hazard ratio 1.78; 95% confidence interval, 1.5–2.13). MASLD was associated with an increased risk of EC in diabetic patients, and lean MASLD has the highest risk. Further studies are required to determine the causal relationship between MASLD and EC.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"49 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140568518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0?","authors":"Angélica Tobón, Albis C Hani, Cristiam D Pulgarin, Andres F Ardila, Oscar M Muñoz, Julian A Sierra, Daniel Cisternas","doi":"10.1093/dote/doad071","DOIUrl":"https://doi.org/10.1093/dote/doad071","url":null,"abstract":"Summary There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland–Altman scatter plots, and Lin’s correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"16 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138824439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and outcomes in a consecutive series of patients with aero-digestive fistula at a tertiary gastro-esophageal surgery center","authors":"Fahad Murad, Fredrik Klevebro, Gert Henriksson, Ioannis Rouvelas, Mats Lindblad, Magnus Nilsson","doi":"10.1093/dote/doad068","DOIUrl":"https://doi.org/10.1093/dote/doad068","url":null,"abstract":"Summary Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138689999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker’s diverticulum: a systematic review and meta-analysis","authors":"Dushyant Singh Dahiya, Smit Deliwala, Saurabh Chandan, Daryl Ramai, Hassam Ali, Lena L Kassab, Antonio Facciorusso, Gursimran S Kochhar","doi":"10.1093/dote/doad069","DOIUrl":"https://doi.org/10.1093/dote/doad069","url":null,"abstract":"Summary Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"35 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"337. PREDICTION OF PULMONARY METASTASIS IN ESOPHAGEAL CARCINOMA PATIENTS WITH INDETERMINATE","authors":"Maohui Chen, Zheng Bin, Hongjin Wang, Yizhou Huang, Shuliang Zhang, Zeng Taidui, Chen Chun","doi":"10.1093/dote/doad052.151","DOIUrl":"https://doi.org/10.1093/dote/doad052.151","url":null,"abstract":"\u0000 \u0000 \u0000 Indeterminate pulmonary nodules (IPNs) are common after surgery for esophageal cancer. The paucity of data on postoperative IPNs for esophageal cancer causes a clinical dilemma.\u0000 \u0000 \u0000 \u0000 The aim of this study was to identify the characteristics and clinical significance of IPNs after radical esophagectomy for metastatic esophageal cancer and determine the risk factors for pulmonary metastasis and construct a risk score model to standardize the appropriate time to either follow up or treat the patient.\u0000 \u0000 \u0000 \u0000 All consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between 2013 and 2016 were included in this retrospective study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and develop risk score models.\u0000 \u0000 \u0000 \u0000 A total of 816 patients were enrolled in the study. During a median follow-up period of 45 months, IPNs were detected in 221 (27.1%) patients, of whom 66 (29.9%) were diagnosed with pulmonary metastases. The following five variables maintained prognostic significance after multivariate analyses: the pathologic N category, number of IPNs, shape of IPNs, time of detection of IPNs, and size of IPNs. The Pulmonary Metastasis Prediction Model (PMPM) scale ranges from 0 to 15 points and patients with higher scores have a higher probability of pulmonary metastases. After validated, the PMPM scale showed good discrimination with an AUC of 0.939.\u0000 \u0000 \u0000 \u0000 A PMPM scale for IPNs in patients who underwent esophagectomy for ESCC may be clinically useful for diagnostic and therapeutic decision-making.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47995604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"444. SHOULD T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA BE SUBCLASSIFIED WITH RESPECT TO LYMPH NODE INVOLVEMENT AND SURVIVAL?","authors":"Y. Gu, Long-Qi Chen","doi":"10.1093/dote/doad052.234","DOIUrl":"https://doi.org/10.1093/dote/doad052.234","url":null,"abstract":"\u0000 \u0000 \u0000 Whether T2 esophageal squamous cell carcinoma should be subclassified into circular muscle (T2a) and longitudinal muscle (T2b) remains controversial. We aimed to investigate the effect of the depth of muscularis propria invasion on the incidence of lymph node involvement and patient survival outcomes in T2 esophageal squamous cell carcinoma.\u0000 \u0000 \u0000 \u0000 We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. The pathological information of the depth of muscularis propria invasion was reassessed, and patients were grouped into the T2a group and T2b group. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan–Meier analysis and a Cox proportional hazard regression model.\u0000 \u0000 \u0000 \u0000 This study included a total of 750 patients from three institutes. The depth of muscularis propria invasion (OR: 3.95, 95% CI: 2.46–6.35; P < 0.001) was correlated with lymph node metastases using logistic regression. T substage (OR: 1.37, 95% CI: 1.05–1.79; P < 0.001) and N status (OR: 1.51, 95% CI: 1.05–2.17; P < 0.001) were independent risk factors in multivariate Cox regression analysis. The T2a group had better overall survival (OR: 1.52, 95% CI: 1.19–1.94; P = 0.001) than the T2b group, specifically in T2N0 patients (OR: 1.38, 95% CI: 1.08–1.94; P = 0.035).\u0000 \u0000 \u0000 \u0000 The depth of muscularis propria invasion should be subclassified to T2a and T2b with respect to lymph node involvement and survival outcomes in T2 esophageal squamous cell carcinoma.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45214770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"264. A RETROSPECTIVE CHART REVIEW OF 85 PATIENTS UNDERGOING THE REFLUXSTOP PROCEDURE TO MANAGE GASTROESOPHAGEAL REFLUX DISEASE: SAFETY AND EFFICACY","authors":"Thorsten Lehmann, M. Simkus, C. Oehler","doi":"10.1093/dote/doad052.105","DOIUrl":"https://doi.org/10.1093/dote/doad052.105","url":null,"abstract":"\u0000 \u0000 \u0000 RefluxStop is a novel surgical device that manages gastroesophageal reflux disease (GERD) by restoring the normal structure of the antireflux barrier. This is accomplished by reinstating the acute angle of His and anchoring the gastroesophageal sphincter adequately in the intraabdominal cavity. This study reports the safety and efficacy of 79 patients in the postoperative period.\u0000 \u0000 \u0000 \u0000 A retrospective chart review was performed on 79 patients that underwent the RefluxStop procedure at a single institution between July 2021 and November 2022 to manage GERD symptoms after informed consent was obtained. Measures were evaluated to assess the feasibility, safety, and clinical outcomes during the follow-up period.\u0000 \u0000 \u0000 \u0000 79 patients (age 49.8 ± 14 years), 46 of which were male, had a mean BMI of 25.8 ± 4.5. Associated conditions noted included esophagitis (45.6%), Barrett’s esophagus (17.7%), and hiatal hernia (57%). Hiatal hernias were large in 35% of cases, with an overall average size of 2.9 cm. Baseline symptoms included general GERD symptoms (35.4%), heartburn (29.1%), cough (13.9%), regurgitation (11.4%), retrosternal burning (10.1%), hoarseness (5.1%), abdominal pain or pressure (3.8%), nausea (2.5%), and others. Baseline GERD health-related quality of life (GERD-HRQL) score was 21.5 ± 5.2 and patients were receiving proton pump inhibitors (PPIs) for a mean of 4.7 ± 6.8 years. After surgery (10.7 ± 3.1 months), all subjects experienced significant improvement in GERD-related symptoms including dysphagia. Only 2.5% of patients required use of PPIs and no subjects required postoperative esophageal dilatation or reoperation. Additionally, there were no severe perioperative complications. Postoperatively, the mean GERD-HRQL score was significantly reduced to 1.6 ± 3.2 (92.6% improvement).\u0000 \u0000 \u0000 \u0000 This study adds to a growing body of evidence that the RefluxStop procedure is safe and effective in management of GERD patients. Notably, a considerable improvement in PPI usage and health-related quality of life parameters were appreciated. Additional studies are required to further validate the role of this procedure in disease management.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45230552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"474. MANOMETRIC IDENTIKIT OF A FUNCTIONING AND EFFECTIVE FUNDOPLICATION IN THE HIGH-RESOLUTION MANOMETRY ERA","authors":"Matteo Santangelo, G. Capovilla, A. Vittori, F. Forattini, L. Provenzano, L. Nicoletti, Andrea Costantini, L. Moletta, M. Valmasoni, M. Costantini, E. Savarino, R. Salvador","doi":"10.1093/dote/doad052.256","DOIUrl":"https://doi.org/10.1093/dote/doad052.256","url":null,"abstract":"\u0000 \u0000 \u0000 Assessing patients following Laparoscopic Fundoplication (LF) can be challenging. Functional information provided by pathophysiological testing—which can shed light on the cause of recurrent symptoms—could be key to clinical decision making. The value of performing High-Resolution Manometry (HRM) after LF is still unclear and debated. We sought to establish the HRM parameters indicative of a functioning fundoplication, and whether HRM could distinguish it from a tight or defective one.\u0000 \u0000 \u0000 \u0000 We studied patients with gastroesophageal reflux disease (GERD) who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication between 2010–2022. HRM and pH monitoring were performed before and 6 months after surgery. LF failure was defined as GerdQ score ≥ 8 and abnormal 24 h-pH study or just abnormal 24 h-pH study. The study population was divided into 5 groups: LN and LT patients with normal pH monitoring (LNpH- and LTpH-, respectively); LN and LT patients with pathological pH monitoring (LNpH+ and LTpH+ groups, respectively); and patients with postoperative severe dysphagia (Dysphagia group). The novel Hiatal Morphology (HM) classification was applied, envisaging 3 subtypes: HM1 (normal morphology); HM2 (intrathoracic fundoplication); and HM3 (slipped fundoplication).\u0000 \u0000 \u0000 \u0000 We recruited 132 patients: 46 in the LNpH- group, 51 in the LTpH- group, 15 in the LNpH+ group, 7 in the LTpH+ group, and 5 in the Dysphagia group (Figure 1). Eight patients with GerdQ score ≥ 8 and normal 24 h-pH findings were excluded. At univariate analysis, postoperative lower esophageal sphincter (LES) basal pressure (p = 0.011), total and abdominal LES length (p = 0.014, p < 0.001) were correlated with LF failure. At multivariate analysis, postoperative abdominal LES length (p = 0.001) and HM2 (p < 0.001) were independently associated with surgical failure. Integrated relaxation pressure (IRP) was significantly higher in the Dysphagia group than in the LNpH- group.\u0000 \u0000 \u0000 \u0000 This study generated reference HRM values for an effective LF and confirms that using HRM to assess the abdominal portion of the neo-sphincter and abnormal hiatal morphology (HM2) improves the clinical assessment of recurrent symptoms. HRM can distinguish patients with a well-functioning wrap from those developing recurrent GERD due to an ineffective wrap. Postoperative IRP also correlated significantly with the onset of dysphagia after surgery.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45427290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"32. QUALITY PERFORMANCE INDICATOR COMPLIANCE FOR THE TREATMENT OF OESOPHAGEAL ADENOCARCINOMA IN NEW ZEALAND","authors":"Yijiao (Joanna) Wang, S. Kulasegaran, S. Srinivasa, J. Koea, A. MacCormick","doi":"10.1093/dote/doad052.012","DOIUrl":"https://doi.org/10.1093/dote/doad052.012","url":null,"abstract":"\u0000 \u0000 \u0000 Oesophageal adenocarcinoma (OAC) is a lethal condition. The management is typically multifaceted with oesophagectomy being the cornerstone of treatment. Quality performance indicators (QPIs) are objective measurements of aspects of patient’s care that affect clinical outcomes. We look to measure a set of clinically relevant QPIs that can be used to capture key aspects of patient management at our institution.\u0000 \u0000 \u0000 \u0000 all patients with OAC treated from 2010 to 2015, and 2020 to 2021 at Te Whatu Ora Waitemata were included. Patients with secondary metastases to the oesophagus or gastric cancer with extension to the oesophagus were excluded. Electronic data in the form of clinic letters, operation notes, histology and radiology reports were reviewed. QPI adherence was collected in binary form.\u0000 \u0000 \u0000 \u0000 QPIs with consistently high compliance rates include radiological staging and histological diagnosis, perioperative dietitian involvement, explanations of disease and treatment intent, and pathology report documentation. QPIs demonstrating significant change and improvement across the two groups include endoscopic resection (60.0% of patients with T1 disease in 2010 to 88.9% in 2020 group), multimodality treatment (majority ECF and ECX perioperative chemotherapy in 2010 to majority FLOT chemotherapy in 2020 group) and minimally invasive approach (30.4% hybrid in 2010 compared to 72.4% hybrid in 2020).\u0000 \u0000 \u0000 \u0000 QPIs from the systematic review were readily measurable and were variably implemented in clinical practice. Areas requiring improvement were identified however relevance to real-world clinical outcomes require further focus of investigation.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44003006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}