Esophagus : official journal of the Japan Esophageal Society最新文献

{"title":"Respiratory sarcopenia defined by paraspinal muscle mass and peak expiratory flow predicts postoperative pneumonia after esophagectomy for esophageal cancer: a comparison with sternocleidomastoid muscle mass.","authors":"Shota Sawai, Shinsuke Sato, Eiji Nakatani, Philip Hawke, Masato Nishida, Hiroshi Ogiso, Masaya Watanabe","doi":"10.1007/s10388-026-01255-7","DOIUrl":"https://doi.org/10.1007/s10388-026-01255-7","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a predictor of postoperative pneumonia after esophagectomy. Recently, respiratory sarcopenia has been proposed as a predictor of postoperative pneumonia that captures respiratory vulnerability more directly than sarcopenia. Respiratory sarcopenia is defined by decreased respiratory muscle strength (RMS) and respiratory muscle mass (RPM). As RPM does not have an established assessment method, previous studies used skeletal muscle mass at L3, including the psoas major (PM) and paraspinal (PS) muscles. However, this may not accurately reflect respiratory muscle status. Therefore, we focused on the sternocleidomastoid (SCM) muscle, an accessory respiratory muscle. We investigated which muscle mass measure for defining respiratory sarcopenia shows the strongest association with postoperative pneumonia after esophagectomy: SCM at C3, PM at L3, or PS at L3.</p><p><strong>Methods: </strong>We reviewed 500 patients who underwent radical subtotal esophagectomy from 2007 to 2024. Based on preoperative CT, muscle mass was calculated as the areas of the three muscles normalized by height squared. RMS was assessed by percent predicted peak expiratory flow (%PEF). Respiratory sarcopenia was defined as low %PEF and low muscle mass. Univariable and multivariable logistic regression evaluated factors associated with postoperative pneumonia.</p><p><strong>Results: </strong>Eighty patients (16.0%) developed postoperative pneumonia. In multivariable analysis, respiratory sarcopenia defined by PS mass was associated with postoperative pneumonia after adjustment for covariates (OR: 2.76, 95% CI 1.32-5.79, P = 0.007). SCM- and PM-based definitions were not significantly associated with postoperative pneumonia.</p><p><strong>Conclusion: </strong>Respiratory sarcopenia defined by decreased %PEF and PS mass is associated with postoperative pneumonia after esophagectomy.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world trends in radiotherapy modalities for esophageal cancer: analysis of a nationwide claims database in Japan.","authors":"Kazuya Takeda, Shinsaku Okuda, Rei Umezawa, Takaya Yamamoto, Noriyoshi Takahashi, Hiroshi Onishi, Keiichi Jingu","doi":"10.1007/s10388-026-01248-6","DOIUrl":"https://doi.org/10.1007/s10388-026-01248-6","url":null,"abstract":"<p><strong>Background: </strong>Recently, the application of Intensity-Modulated Radiotherapy (IMRT) and changes in fractionation schedules have been increasingly introduced in radiotherapy practice for esophageal cancer. However, the extent of their adoption and prevalence in real-world clinical practice remains unclear. This study aimed to describe nationwide trends in radiotherapy for esophageal cancer using a large-scale health insurance claims database.</p><p><strong>Methods: </strong>Using the DeSC database, we identified patients newly diagnosed with esophageal cancer between April 2017 and March 2023. Patients treated with definitive radiotherapy (defined as 25-35 treatment days in patients without distant metastasis) were selected. We analyzed temporal trends in radiotherapy, regional differences, and the incidence of radiation pneumonitis.</p><p><strong>Results: </strong>Among patients with an identified initial treatment, the proportion of radiotherapy declined from 28.6% in 2017 to 19.6% in 2022. A total of 1,324 patients were included in the definitive radiotherapy group. The use of IMRT increased substantially from 10.7% in 2017 to 44.9% in 2022. Regarding fractionation, treatments of 25-28 days increased from 25.0% to 35.9%, while those of 31-35 days decreased. While CDDP/5-FU remained the dominant concurrent chemotherapy, its proportion declined as other platinum-based regimens increased. Urban facilities showed significantly higher implementation of Image-Guided Radiotherapy (IGRT) compared with rural facilities. The cumulative incidence of hospitalization for radiation pneumonitis at 12 months was 1.5%. The cumulative incidence was not significantly altered by IMRT use (sHR: 0.32, p = 0.13), whereas it was lower in patients receiving IGRT (sHR: 0.39, p = 0.04).</p><p><strong>Conclusions: </strong>This nationwide study demonstrated increased use of advanced techniques including IMRT and IGRT, and shorter fractionation schedules in radiotherapy for esophageal cancer in Japanese clinical practice.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with marked reduction in tongue pressure in patients with esophageal cancer during neoadjuvant chemotherapy.","authors":"Takuya Fukushima, Makoto Yamasaki, Nobuyuki Yamamoto, Yasuaki Arima, Taisei Ashida, Shuta Takaishi, Hanako Koda, Satoshi Toshiyama, Takashi Harino, Yuki Hashimoto, Masaya Kotsuka, Takuji Sato, Kentaro Inoue, Kimitaka Hase, Jiro Nakano","doi":"10.1007/s10388-026-01246-8","DOIUrl":"https://doi.org/10.1007/s10388-026-01246-8","url":null,"abstract":"<p><strong>Background: </strong>Tongue pressure is a predictor of postoperative aspiration. This study aimed to examine changes in tongue pressure during neoadjuvant chemotherapy (NAC), identify associated factors, and investigate whether these changes are related to other functional outcomes, including exercise capacity and muscle function.</p><p><strong>Methods: </strong>This prospective, single-center, observational study enrolled 68 patients with esophageal cancer scheduled to undergo NAC. Patients were classified into marked reduction (n=17) and remaining (n=51) groups based on the rate of change in tongue pressure. Tongue pressure, muscle function, walking ability, and exercise capacity were evaluated before and after NAC. Multivariate logistic regression analysis was performed to identify the factors significantly associated with a marked reduction in tongue pressure. Spearman's correlation analysis was used to evaluate the relationships between the rate of change in tongue pressure and the rates of change in each functional parameter.</p><p><strong>Results: </strong>Multivariable logistic regression analysis identified age and the number of days during NAC when oral intake was not possible as significant independent factors associated with a marked reduction in tongue pressure. Spearman's correlation analysis revealed no significant correlations between the rate of change in tongue pressure during NAC and the rates of change in handgrip strength, isometric knee extensor strength, 30-s chair stand test performance, quadriceps thickness, maximum inspiratory pressure, maximum expiratory pressure, 10-m walk test result, or 6-min walk distance.</p><p><strong>Conclusions: </strong>These findings underscore the importance of incorporating swallowing function, including tongue pressure, into prehabilitation programs.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-resolution 3D micro-CT reveals an additional muscle layer in esophageal atresia.","authors":"Daniel Docter, Anastasia Ioannidou, Bernadette de Bakker, Joris J T H Roelofs, Sjoerd de Beer, Sander Zwaveling, Jermo Hanemaaijer-van der Veer, Jon Sporring, Joep Derikx, Matthijs Oomen, Michiel van Wijk, Ramon Gorter","doi":"10.1007/s10388-026-01242-y","DOIUrl":"https://doi.org/10.1007/s10388-026-01242-y","url":null,"abstract":"<p><strong>Background: </strong>Esophageal atresia (EA) is a congenital malformation intrinsically associated with esophageal dysmotility. Its etiology is poorly understood and it is unclear why motility is better preserved in some patients than in others. Esophageal motility is a three-dimensional (3D) process orchestrated by microscale structures, but conventional histology offers two-dimensional insight in the organization of the esophageal wall, hindering the identification of subtle, but potentially relevant, microarchitectural abnormalities that may contribute to understanding of the etiology of EA and variability in motility patterns. We aimed to evaluate the 3D microscale architecture of the esophagus in EA patients and identify potential anomalies using microfocus computed tomography (micro-CT).</p><p><strong>Methods: </strong>Full thickness esophageal samples from the proximal and distal pouch of eleven neonates undergoing EA repair and three fetal control esophagus samples (gestational age: 24 weeks) were collected, contrast-enhanced, and imaged with high-resolution micro-CT (2-5 μm voxel size). Muscle layers were segmented using the machine learning software RootPainter and EA samples were compared with the fetal controls. Findings were validated by histology.</p><p><strong>Results: </strong>Micro-CT enabled clear visualization of epithelial, submucosal, vascular, and muscular structures in all samples. 3D reconstructions consistently revealed a previously unreported oblique muscle layer situated medial to the circular muscle layer in all EA specimens. This layer varied in prominence and was not recognizable on 2D histology alone. Fetal control samples displayed only the typical circular and longitudinal layers, with oblique muscle fibres confined to the stomach.</p><p><strong>Conclusion: </strong>Three-dimensional assessment of esophageal microarchitecture using micro-CT allows differentiation between epithelium, musculature and vascularization. Moreover, it facilitated the identification of an oblique muscle layer in proximal pouch and distal trachea-esophageal fistula specimens from EA patients. It remains to be studied whether these findings can explain the observed variation in motility patterns in EA patients.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-dependent and independent prognostic value of inflammation-based nutritional indices in immune checkpoint inhibitor-based therapy for esophageal cancer.","authors":"Hiroki Matsuda, Tomoki Makino, Shuichiro Hara, Shigeto Nakai, Takaomi Hagi, Kota Momose, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Atsushi Takeno, Tsuyoshi Takahashi, Masaaki Motoori, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki","doi":"10.1007/s10388-026-01243-x","DOIUrl":"https://doi.org/10.1007/s10388-026-01243-x","url":null,"abstract":"<p><strong>Background: </strong>Phase III trials have established the efficacy of immune-based therapies for unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC). However, real-world evidence comparing regimens and clinically applicable prognostic biomarkers remains limited.</p><p><strong>Methods: </strong>We retrospectively evaluated 245 patients with unresectable advanced/recurrent ESCC treated with first-line 5-fluorouracil plus cisplatin combined with nivolumab or pembrolizumab (CF + ICI; n = 114), first-line ipilimumab plus nivolumab (Ipi + Nivo; n = 46), or nivolumab monotherapy as second-line or later treatment (Nivo; n = 85). Efficacy, safety, and survival outcomes were assessed, focusing on inflammation-based nutritional indices and multivariate prognostic modelling.</p><p><strong>Results: </strong>The objective response rates were 56%, 53%, and 27%, and the median overall survival was 26, 73, and 13 months in the CF + ICI, Ipi + Nivo, and Nivo groups, respectively. No treatment-related deaths occurred. In multivariate analyses, Glasgow Prognostic Score (GPS) ≥ 2 independently predicted poor survival across all regimens. High platelet-to-lymphocyte ratio (PLR) was independently associated with poor survival only in chemotherapy-free ICI regimens (Ipi + Nivo and Nivo). A pooled model showed a significant interaction between treatment regimen and PLR (p = 0.047).</p><p><strong>Conclusions: </strong>In real-world practice, GPS provides regimen-independent prognostic stratification, whereas PLR shows treatment-dependent prognostic relevance, supporting its potential utility for biomarker-guided and individualized treatment selection in ESCC.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between metabolic syndrome-related parameters and endoscopic classification of gastroesophageal reflux disease: a Japanese health checkup cohort study.","authors":"Naohiko Nakamura, Yuji Nakatuji, Ryuji Hayashi","doi":"10.1007/s10388-026-01247-7","DOIUrl":"https://doi.org/10.1007/s10388-026-01247-7","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of gastroesophageal reflux disease (GERD) has increased worldwide, and metabolic syndrome (MS) was reported as a risk factor for its incidence. This study retrospectively evaluated the relationship between endoscopic GERD classification and MS-related parameters in a Japanese cohort.</p><p><strong>Methods: </strong>We reviewed the medical records of 3,635 adults who underwent upper gastrointestinal endoscopy as part of health checkups. Based on endoscopic findings, GERD was classified according to the Los Angeles (LA) system. Body mass index (BMI), waist circumference, blood pressure (BP), and laboratory parameters-including glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides-were compared across the LA grade groups.</p><p><strong>Results: </strong>The numbers of patients classified as LA grade N, M, A, B, C, and D were 2,557 (70.3%), 404 (11.1%), 566 (15.6%), 88 (2.4%), 19 (0.5%), and 1 (0.0%), respectively. BMI, waist circumference, and BP increased progressively from grade N to grade C. Patients with grades A or B exhibited significantly higher glucose, LDL-C, and triglyceride levels and lower HDL-C levels than grade N patients. A similar trend was observed in subgroup analyses of non-obese individuals (BMI < 25). Multivariate analyses identified increased BMI, triglyceride, and LDL-C levels as significant independent factors associated with erosive esophagitis of grade A or higher in both the overall and non-obese groups.</p><p><strong>Conclusions: </strong>Patients with more severe GERD grades demonstrated worsening of MS-related parameters, even in the absence of obesity. These parameters may be useful for predicting the endoscopic severity of GERD.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic repair of an esophago-left main bronchial fistula using a pedicled autologous pericardial patch and latissimus dorsi muscle flap: a novel technique after chemoradiotherapy for cT4b esophageal cancer.","authors":"Tomoki Makino, Shigeto Nakai, Tomohira Takeoka, Kotaro Yamashita, Kazuya Kuroda, Koji Tanaka, Takashi Kanou, Tateki Kubo, Yasushi Shintani, Shigeru Miyagawa, Hidetoshi Eguchi, Yuichiro Doki","doi":"10.1007/s10388-026-01235-x","DOIUrl":"10.1007/s10388-026-01235-x","url":null,"abstract":"<p><p>Once an esophago-airway fistula develops during chemoradiotherapy for cT4b esophageal cancer, further curative treatment is often precluded. We describe a robotic technique for closure of a large esophago-left main bronchial fistula using a pedicled autologous pericardial patch reinforced with a latissimus dorsi muscle flap. A 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus invading the left main bronchus developed a fistula after definitive chemoradiotherapy. After temporary airway stenting, salvage surgery was performed in the semi-prone position under single-lung ventilation and CO₂ pneumothorax. Following thoracic esophagectomy, a horseshoe-shaped pedicled pericardial patch was created robotically, flipped cranially, and sutured to the bronchial defect. A right latissimus dorsi muscle flap was then introduced into the right thoracic cavity through a second intercostal opening and robotically fixed over the repair. To our knowledge, this is the first report of this robotic technique.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance of combining circulating tumor DNA and endoscopic response evaluation for esophageal squamous cell carcinoma.","authors":"Yuki Hoshi, Satoru Matsuda, Kohei Nakamura, Hirofumi Kawakubo, Keiso Ho, Ryota Kobayashi, Takayuki Tsuji, Masashi Takeuchi, Kazumasa Fukuda, Hiroshi Nishihara, Yuko Kitagawa","doi":"10.1007/s10388-026-01245-9","DOIUrl":"https://doi.org/10.1007/s10388-026-01245-9","url":null,"abstract":"<p><strong>Background: </strong>We previously demonstrated the usefulness of circulating tumor DNA (ctDNA) in blood for assessing tumor burden for esophageal squamous cell carcinoma (ESCC). We also found that endoscopic response evaluation predicted the prognosis of ESCC patients. In this study, we determined whether the combination of post-NAC ctDNA with endoscopic evaluation can improve the prediction of the prognosis in ESCC patients.</p><p><strong>Methods: </strong>Thirty-one patients with ESCC treated with neoadjuvant chemotherapy (NAC) and surgery at Keio University Hospital between 2019 and 2024 were reviewed. Blood samples for ctDNA analysis were collected before and after NAC. An endoscopic responder (ER) was defined based on the endoscopic findings. Patients were classified into three groups by post-NAC ctDNA and ER status: (A) ctDNA-negative and ER, (B) ctDNA-negative and non-ER, and (C) ctDNA-positive. Recurrence-free survival (RFS) and pathological lymph node status were investigated.</p><p><strong>Results: </strong>Sixty blood samples were collected from 31 patients. Of these patients, 29 were ctDNA-positive before NAC, and 13 became negative after NAC. ER was observed in 10 patients. Three-year RFS was significantly higher in ctDNA-negative than in ctDNA-positive (74% vs. 12%, p = 0.001). When combining ctDNA and ER, group A had no recurrences during follow-up. Three-year RFS rates for groups A, B, and C were 100, 53, and 12%, respectively (p = 0.004). 80% of group A patients showed no lymph node metastasis.</p><p><strong>Conclusions: </strong>The combination of post-NAC ctDNA and ER predicts the prognosis more accurately. These indicators will individualize ESCC treatment.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional enrollment volume and clinical outcomes after surgery or chemoradiotherapy for clinical stage I esophageal squamous cell carcinoma: a supplementary analysis of JCOG0502.","authors":"Kazuhiro Shiraishi, Ken Kato, Yuya Ishikawa, Keita Sasaki, Hiroyuki Daiko, Yoshinori Ito, Takeshi Kajiwara, Takashi Kojima, Hiroshi Miyata, Masaki Ueno, Satoru Nakagawa, Shinsuke Sato, Shigeru Tsunoda, Tetsuya Abe, Yoshiaki Nagatani, Yoichi Hamai, Yasue Kimura, Kenro Hirata, Takahiro Tsushima, Hiroya Takeuchi","doi":"10.1007/s10388-026-01244-w","DOIUrl":"https://doi.org/10.1007/s10388-026-01244-w","url":null,"abstract":"<p><strong>Background: </strong>Surgery and chemoradiotherapy (CRT) are standard options for clinical stage I esophageal squamous cell carcinoma (ESCC). JCOG0502, a multicenter, non-randomized, parallel-group comparison, demonstrated the non-inferiority of definitive CRT compared with surgery for overall survival (OS) in patients with cT1bN0M0 ESCC; however, institutional differences may influence outcomes. This study explored inter-institutional heterogeneity in survival and adverse events (AEs) among patients in JCOG0502.</p><p><strong>Methods: </strong>Among 379 enrolled patients, 364 were analyzed. Institutions enrolling ≥ 13 patients, corresponding to the median institutional trial enrollment, were classified as high-enrollment institutions (High), whereas those enrolling < 13 patients were classified as low-enrollment institutions (Low). Institutional trial enrollment was evaluated as an exploratory indicator, rather than as a direct measure of institutional case or procedural volume. The primary endpoint was OS. Secondary endpoints were progression-free survival (PFS) and AEs.</p><p><strong>Results: </strong>In the surgery group, institutional trial enrollment volume was not significantly associated with OS (HR for High vs. Low, 0.73; 95% CI, 0.40-1.35). Similarly, no significant association was observed in the CRT group (HR, 1.12; 95% CI, 0.59-2.13). Findings for PFS were consistent with these OS results in both groups. Myocardial ischemia or infarction occurred in 5 patients in Low and none in High in the CRT group.</p><p><strong>Conclusions: </strong>No clear association was identified between institutional trial enrollment volume and survival outcomes in either the surgery or CRT group. However, clinically meaningful differences could not be excluded. The observed differences in selected toxicities, including myocardial ischemia, should be considered hypothesis-generating.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-cigarette use and Barrett's esophagus: evaluating a new risk in the era of vaping.","authors":"Boniface Mensah, Albert E Orhin, Natalie A Y Akoto, Aida Metri, Rachel A Boateng, Seunghee Han, Kevin Eid, Simardeep Singh, Haider A Naqvi, Cadman L Leggett","doi":"10.1007/s10388-026-01240-0","DOIUrl":"https://doi.org/10.1007/s10388-026-01240-0","url":null,"abstract":"<p><strong>Introduction: </strong>The association between electronic cigarette (e-cigarette) use and Barrett's esophagus (BE) is still unclear. While traditional, combustible cigarette smoking is a known risk factor for BE, growing evidence on e-cigarette exposure has raised concerns about potential esophageal injury. Our aim is to evaluate the relationship between e-cigarette use and BE in a large and diverse population.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using the All of Us Research Program to examine the association between e-cigarette use and BE. Adults aged 18 years or older with an ICD-10 diagnosis of BE (K22.7) were included. E-cigarette exposure was categorized as (1) ever vs. never use, (2) former vs. current vs. never use, and (3) dual use (concurrent e-cigarette and traditional cigarette smoking). Covariates including demographics, BMI, smoking status, alcohol use, GERD, hiatal hernia, diabetes, NSAID use, education, income, employment, and insurance status, were obtained. Multivariable logistic regression estimated adjusted odds ratios (AORs) with 95% confidence intervals.</p><p><strong>Results: </strong>Among the 328,022 individuals studied, 29,343 (9%) reported e-cigarette use. E-cigarette users were younger and had lower rates of diabetes and GERD. After adjusting for relevant factors, we found that ever e-cigarette use was associated with higher odds of BE (OR 1.21, 95% CI 1.06-1.39). When we stratified by patterns of use, current e-cigarette use was significantly associated with BE (OR 1.46, 95% CI 1.15-1.83), whereas former use was not (OR 1.12, 95% CI 0.96-1.31). Individuals who were dual users also had increased odds of BE (OR 1.22, 95% CI 1.05-1.41). As expected, smoking, older age, hiatal hernia, and GERD remained strong predictors across all models, with GERD showing the strongest relationship.</p><p><strong>Discussion: </strong>In this large national cohort, current and dual e-cigarette use were associated with increased odds of BE after adjustment for established risk factors, including GERD and combustible cigarette smoking. These findings suggest that e-cigarette use may represent a modifiable and underrecognized contributor to esophageal mucosal injury. Prospective longitudinal studies are needed to establish causality and clarify the mechanisms underlying this association.</p>","PeriodicalId":520612,"journal":{"name":"Esophagus : official journal of the Japan Esophageal Society","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}