Diseases of the Esophagus最新文献

{"title":"Effects of immunoenteric nutrition versus general enteral nutrition on prognosis in patients with squamous cell carcinoma undergoing radical esophagectomy post neoadjuvant chemotherapy.","authors":"Guanghui Zhu, Xiaobin Song, Qin Wang, Zheng Zhang, Maotian Xu, Fei Xu, Jing Luo, Chi Zhang, Yi Shen","doi":"10.1093/dote/doaf027","DOIUrl":"https://doi.org/10.1093/dote/doaf027","url":null,"abstract":"<p><p>Malnutrition is a common complication among patients with esophageal cancer, significantly increasing the risk of postoperative complications and mortality. Multiple studies have shown that immunoenteric nutrition (IEN) can reduce postoperative infectious complications in patients with esophageal cancer. However, its prognostic impact on patients undergoing radical surgery following neoadjuvant therapy remains unclear. This study aimed to compare the prognostic effects of IEN versus standard enteral nutrition (EN) in patients with esophageal squamous cell carcinoma (ESCC) following radical esophageal cancer surgery after neoadjuvant therapy. This retrospective study included 197 patients with ESCC who underwent radical esophagectomy following neoadjuvant therapy between 2016 and 2022. Of these, 133 patients received postoperative standard EN, while 64 patients received IEN. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints included the incidence of postoperative complications and changes in relevant blood markers before and after surgery. No significant differences were observed in postoperative hospitalization duration or complications between the two groups. Postoperative C-reactive protein and immunoglobulin M levels were significantly lower in the IEN group compared to the EN group (P = 0.018 and 0.042). Kaplan-Meier survival curves were plotted for 1, 2, 3, and 5 years to compare the effects of IEN and EN on OS and PFS. The log-rank test revealed the following survival rates: 90.6% versus 77.2% (1-year PFS, P = 0.023); 95.3% versus 82.7% (1-year OS, P = 0.015); 71.9% versus 56.7% (2-year PFS, P = 0.035); 76.6% versus 62.4% (2-year OS, P = 0.03); 54.6% versus 41.7% (3-year PFS, P = 0.064); 61.4% versus 49.3% (3-year OS, P = 0.08); 39.4% versus 30.7% (5-year PFS, P = 0.093); and 41.5% versus 32.6% (5-year OS, P = 0.104). Univariate and multivariate analyses identified several independent predictors of 2-year PFS and OS. For 2-year PFS, the independent predictors included body mass index (P = 0.005), ypTNM stage (Pathologic TNM-staging after neoadjuvant therapy) (P = 0.045), ypT stage (Pathologic T-staging after neoadjuvant therapy) (P = 0.030), ypN stage (Pathologic N-staging after neoadjuvant therapy) (P = 0.007), tumor differentiation (P = 0.031), and type of EN (P = 0.004). For 2-year OS, the independent predictors were age (P = 0.015), body mass index (P = 0.004), ypTNM stage (P = 0.013), ypT stage (P = 0.010), ypN stage (P = 0.009), tumor differentiation (P = 0.026), and type of EN (P = 0.001). In patients with ESCC undergoing esophagectomy after neoadjuvant therapy, postoperative IEN accelerates the resolution of the inflammatory state and improves short-term survival, though its long-term benefits remain uncertain. Furthermore, IEN does not significantly affect the postoperative hospitalization duration or the incidence of complications.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042210","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":"Impact on Barrett's dysplasia yield following the introduction of capsule sponge testing versus traditional endoscopic surveillance.","authors":"Siobhan Chien, Paul Glen","doi":"10.1093/dote/doaf033","DOIUrl":"https://doi.org/10.1093/dote/doaf033","url":null,"abstract":"<p><strong>Background: </strong>Capsule sponge testing for Barrett's surveillance is emerging as an innovative technology to aid endoscopic surveillance programs but has yet to be compared to traditional endoscopy in clinical practice. This study aims to establish the impact of the introduction of capsule sponge testing on dysplasia detection rates.</p><p><strong>Methods: </strong>Over a 5-year period, data were collected for all patients undergoing endoscopy and capsule sponge testing for Barrett's surveillance in a single health board. The 2-year periods pre- and post-implementation of capsule sponge testing were compared to assess dysplasia yield. Patients undergoing surveillance over the 2-year period 1 January 2021 to 31 December 2022 were dichotomized into two groups: capsule sponge test (±subsequent endoscopy) versus endoscopic surveillance only, to compare endoscopic biopsy results.</p><p><strong>Results: </strong>Barrett's surveillance was performed in 1568 patients between 1 January 2018 and 31 December 2019 (pre-intervention group) versus 1791 patients between 1 January 2021 and 31 December 2022 (implementation group). In the implementation group, 871 patients underwent traditional endoscopy versus 920 patients undergoing capsule sponge testing (with 157 patients [17.1%] proceeding to endoscopy after capsule sponge test). There were no significant differences in the rates of high grade dysplasia (HGD), intramucosal cancer (IMC), or invasive cancer diagnosed between the groups. However, yield of indefinite for dysplasia and low grade dysplasia (LGD) cases was higher in the endoscopic surveillance cohort.</p><p><strong>Conclusions: </strong>Capsule sponge testing is non-inferior to traditional endoscopic surveillance for detecting HGD, IMC, and cancer. Further follow-up is required to ensure early dysplasia is diagnosed appropriately in those undergoing capsule sponge testing for Barrett's surveillance.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095831","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":"Computing lifetime incidence of esophageal adenocarcinoma and age-specific prevalence of Barrett's esophagus.","authors":"Ravi Vissapragada, Norma B Bulamu, David C Whiteman, Tim Bright, Jonathan Karnon, David I Watson","doi":"10.1093/dote/doaf038","DOIUrl":"10.1093/dote/doaf038","url":null,"abstract":"<p><p>Barrett's esophagus is the precursor to esophageal adenocarcinoma. Esophageal adenocarcinoma detected from endoscopic surveillance programs accounts for <10% of all cases, suggesting majority of patients with Barrett's esophagus are likely unaccounted for. Previous observational studies have estimated the observed prevalence of Barrett's esophagus to be approximately 1%, but others suggest may be an underestimate. The aim of this study was twofold: (i) calculate lifetime risk of esophageal adenocarcinoma and (ii) estimate overall and age-specific prevalence of Barrett's esophagus. A tree cohort model was created for progression to esophageal adenocarcinoma from birth to death (100 years) for USA and Australian population. Lifetime risk of esophageal cancer and adenocarcinoma were necessary for calculating Barrett's esophagus prevalence. The model incorporated age- and sex-specific incidence data from national cancer registries: the Australian Institute of Health and Welfare and the Surveillance, Epidemiology, and End Results database for the USA. The model was calibrated using an optimization algorithm, which matched progression rates from Barrett's esophagus to esophageal adenocarcinoma with known national cancer data. A Monte Carlo simulation, with 10,000 iterations, was conducted to derive error margins. Estimates of age-specific and overall prevalence of Barrett's esophagus in the population were generated through a similar process. Results: The lifetime risk of esophageal cancer and adenocarcinoma in USA non-Hispanic White population was 0.56% and 0.36%, respectively, while it was somewhat higher at 0.81% and 0.61% (range 0.57%-0.65%) in the Australian population. Estimated overall prevalence of Barrett's esophagus was ~3% (±0.3%) and ~ 5.4% (±0.6%) in USA White and Australian populations (male and female). Prevalence for age brackets was estimated at 0.06% (±0.02%), 1.6% (±0.7%), 3.2% (±1.3%), 8% (±3%), and 12% (±4%) for USA, and 0.05% (±0.02%), 0.9% (±0.5%), 2.8% (±1.2%), 7% (±3%), and 12% (±4%) for Australian population for ages 0-29, 30-44, 45-59, 60-74, and 75+, respectively. Observed estimates of Barrett's esophagus prevalence are likely lower than projected overall prevalence. This study also presents age-specific prevalence estimates of Barrett's esophagus, which are key in developing screening programs for esophageal adenocarcinoma.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of delayed gastric conduit emptying after esophagectomy: a retrospective single-center study.","authors":"Andreas Damtoft, Jens Osterkamp, August A Olsen, Pieter De Heer, Michael Patrick Achiam","doi":"10.1093/dote/doaf040","DOIUrl":"https://doi.org/10.1093/dote/doaf040","url":null,"abstract":"<p><p>Delayed gastric conduit emptying (DGCE) after esophagectomy is a major cause of morbidity and reduced quality of life. The reported incidence varies greatly (2.2-47%), partly due to a lack of consensus on the definition of DGCE. Recently, an international expert consensus proposed diagnostic criteria for Early-DGCE (E-DGCE) and Late-DGCE (L-DGCE) alongside a symptom severity score. Using these criteria, we investigated the incidence and predictors of DGCE in a large cohort. All patients undergoing esophagectomy with pyloroplasty at Rigshospitalet, Denmark, between 2016 and 2021 were reviewed. E- and L-DGCE were defined using the proposed criteria (5-14 days and > 14 days after surgery, respectively). Specialist nurses followed patients for up 2 years at predefined intervals. About 387 patients were included. The incidence of E-DGCE was 174/387 (45%), and 155/387 (40%) patients presented with L-DGCE at least once during follow-up. The highest prevalence of L-DGCE (19.6%) was identified at postoperative day 28 (POD28) but decreased to 2.9% at the 2-year follow-up. A BMI of ≥30 was a predictor of E-DGCE (P = 0.004) and L-DGCE at POD28 (P = 0.01). No association between E-DGCE and L-DGCE was identified. Using the proposed criteria, the incidence of E-DGCE and prevalence of L-DGCE at POD28 was high. The prevalence of L-DGCE was dynamic but decreased greatly during follow-up. Future prospective studies with multiple follow-ups are needed to validate our findings and the usefulness of the criteria in a clinical setting.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175662","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":"The effect of prophylactic cruroplasty on the incidence of hiatal herniation after robot-assisted minimally invasive esophagectomy (RAMIE).","authors":"Cezanne D Kooij, Eline M de Groot, Lucas Goense, B Feike Kingma, Hylke J F Brenkman, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1093/dote/doaf041","DOIUrl":"https://doi.org/10.1093/dote/doaf041","url":null,"abstract":"<p><strong>Background: </strong>Hiatal herniation (HH) following esophagectomy can cause severe complications and affect functional outcomes. This study assessed whether prophylactic cruroplasty during robot-assisted minimally invasive esophagectomy (RAMIE) reduces HH incidence.</p><p><strong>Methods: </strong>Patients undergoing curative RAMIE with cervical anastomosis for esophageal cancer at a high-volume center were included. Cruroplasty became routine in 2017 unless the hiatus was narrow. The primary outcome was HH incidence with versus without cruroplasty. Median follow-up was calculated using the reverse Kaplan-Meier method. Kaplan-Meier curves assessed HH-free survival and cumulative incidences up to 4 years, considering the time-dependent nature of HH. The log-rank test compared groups. Multivariable Cox regression evaluated the association between cruroplasty and HH, with hazard ratios (HR) and 95%-confidence interval (95%CI).</p><p><strong>Results: </strong>Between 2003 and 2023, 366 patients underwent RAMIE with cervical anastomosis. Median follow was 81 months (95%CI 71-91). In the cruroplasty group, 5 (5%) developed a HH (2 symptomatic, 3 asymptomatic), while 23 (9%) of patients without cruroplasty developed a HH (5 acute, 8 symptomatic, 10 asymptomatic). Most HHs were detected within 2 years (71%; n = 20). The 4-year cumulative incidence was 5.7% with cruroplasty and 11.1% without (P = 0.289). Imaging was performed in 77 of 101 patients (76%) with cruroplasty and 228 of 265 patients (86%) without cruroplasty. Cox regression revealed no significant association between cruroplasty and HH (HR 0.652, 95%CI 0.244-1.740).</p><p><strong>Conclusion: </strong>Prophylactic cruroplasty may reduce HH in RAMIE with cervical anastomose, though it cannot always prevent HH. Further research is warranted to confirm these findings and evaluate its role in other types of esophagectomy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163778","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":"Recurrent laryngeal nerve paralysis as a potential mediator of complications in esophagectomy following lymph node dissection.","authors":"Zhuoheng Lv, Ligong Yuan, Yousheng Mao, Siyuan Ai","doi":"10.1093/dote/doaf028","DOIUrl":"https://doi.org/10.1093/dote/doaf028","url":null,"abstract":"<p><p>Complications from esophagectomy often interact with each other, with those related to recurrent laryngeal nerve (RLN) paralysis (RLNP) being particularly significant. Aggressive dissection of RLN lymph nodes (RLN-LNs) is considered a major contributing factor to RLNP. This study seeks to validate the hypothesis that RLNP acts as a mediator, not only resulting from RLN-LN dissection but also amplifying the likelihood of other postoperative complications. Data were retrospectively extracted from the Chinese 12th Five-Year Major Science and Technology Project on esophageal diseases, including a cohort of 1684 patients enrolled between 2015 and 2018. Both univariate and multivariate structural equation models were employed to validate the mediating role of RLNP in postoperative complications. Without causing RLNP, RLN-LN dissection directly increased the risk of chylothorax (odds ratio [OR] = 1.179, 95% confidence interval [CI] = 1.003-1.385) and decreased the risk of cardiac arrhythmia (OR = 0.919, 95% CI = 0.838-0.993). Meanwhile, through the mediating effect of RLNP, RLN-LN dissection indirectly led to complications requiring intensive care (OR = 1.043, 95% CI = 1.004-1.083) and conservative therapy (OR = 1.043, 95% CI = 0.996-1.092). RLNP serves as a critical mediator between RLN-LN dissection and subsequent postoperative complications requiring intensive care and conservative therapy. Recognizing that many of these complications are mediated by RLNP could help thoracic surgeons prioritize neural protection during RLN-LN dissection, potentially reducing the overall risk of multiple complications and alleviating the associated concerns.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136568","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":"No advantage of fundoplication in paraesophageal hernia repair: a retrospective multicenter study.","authors":"Lene Østerballe, Eirik K Aahlin, Rasmus Goll, Mahdi Alamili, Per-Even Storli, Mads V Gran, Cecilie B Lassen, Palle B Miliam, Kim E Mortensen","doi":"10.1093/dote/doaf036","DOIUrl":"10.1093/dote/doaf036","url":null,"abstract":"<p><p>Paraesophageal hernia repair often includes both gastropexy and fundoplication. The fundoplication may cause persistent side effects, and the necessity of the procedure is uncertain. This study aimed to compare gastropexy with or without fundoplication. A retrospective multicenter study was conducted from three Scandinavian hospitals. Patients, with grade III-IV hiatal hernia, who had a laparoscopic repair with total hernia sack removal, closure of hiatus, gastropexy either with or without Nissen fundoplication were included. Outcomes were per- and postoperative complications, postoperative symptom control, and recurrence. A total of 320 patient cases were included in the study (72 patients with Nissen fundoplication and 248 patients without fundoplication). Baseline variables were comparable between the two groups. We found no difference in perioperative or postoperative events, reflux control or recurrence. Median operation time differed with 49 minutes (P < 0.001) in patients with fundoplication (Median: 108 minutes, interquartile range (IQR): 88-131 minutes) compared to patients without fundoplication (59 minutes, IQR = 46-78 minutes). We also found an increased risk for second repair in the fundoplication group (OR 4.3, 95% CI 1.4-13.3). This study shows no benefits of adding a Nissen fundoplication procedure to anterior gastropexy for paraesophageal hernia repair. It was not superior compared to gastropexy alone in terms of postoperative reflux control or preventing recurrence. In contrast, the fundoplication was associated with a four-fold increase of second repair, but the study design limits firm conclusions on this matter.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of computed tomography and endoscopy in caustic esophageal injury in adults: a systematic review.","authors":"Elisa Bass, John Asher Jenkins, Juan M Farina, Andrew Saleeb, Staci E Beamer, Dawn E Jaroszewski, Samine Ravanbakhsh, Cecilia Benz, Pedro Reck Dos Santos, Jonathan D'Cunha","doi":"10.1093/dote/doaf037","DOIUrl":"https://doi.org/10.1093/dote/doaf037","url":null,"abstract":"<p><p>Caustic esophageal injury can cause severe morbidity and mortality. Despite the need for emergent treatment, individual experience in diagnosis and management can be limited. Computed tomography (CT) has emerged as a promising non-invasive modality for assessing injury severity, but the clinical utility of both CT and endoscopy should be investigated. A systematic review was conducted following PRISMA guidelines. A comprehensive search of the PubMed database identified relevant articles published from January 1, 2000 to December 31, 2023. Inclusion criteria encompassed studies investigating the use of CT and/or endoscopy in diagnosing and managing caustic esophageal injury. Twelve articles were selected from a pool of 931 studies. Findings suggested that CT was superior in diagnostic capability to endoscopy in high-grade injury and stricture formation, but less so for low grade injuries. Diagnostic algorithms incorporating imaging with laboratory studies have emerged in the literature, which are promising pending additional validation. CT can serve as a valuable, non-invasive tool in the initial evaluation of caustic esophageal injury and is postulated to accurately predict both the need for emergent surgery and the risk of stricture formation. However, CT should not replace but rather complement the use of endoscopy to comprehensively evaluate these potentially highly morbid situations.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095823","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":"Endoscopic response to topical steroids is associated with a need for fewer future esophageal dilations.","authors":"Timothy S Gee, Sean S LaFata, Hannah L Thel, Brenderia A Cameron, Angela Z Xue, Akshatha Kiran, Adolfo A Ocampo, Justin McCallen, Christopher J Lee, Stephanie A Borinsky, Walker D Redd, Trevor S Barlowe, Rayan N Kaakati, Cary C Cotton, Swathi Eluri, Craig C Reed, Evan S Dellon","doi":"10.1093/dote/doaf032","DOIUrl":"https://doi.org/10.1093/dote/doaf032","url":null,"abstract":"<p><p>The eosinophilic esophagitis (EoE) Endoscopic Reference Score (EREFS) measures endoscopic severity. While a score of ≤2 has been proposed for endoscopic response, it is unknown whether achieving this threshold results in clinically important outcomes. We aimed to determine whether an EREFS response to topical steroids (tCS) is associated with a decreased need for future esophageal dilation. In this retrospective cohort study, we included patients with a new diagnosis of EoE who underwent esophageal dilation, were then treated with tCS, and had at least two follow-up endoscopies. Endoscopic response was defined as EREFS ≤2. Histological and global symptom responses were recorded. We compared patients with and without endoscopic response and calculated the number of subsequent dilations in each group. Of 113 EoE patients, 55 (49%) had endoscopic response post-tCS. Compared to endoscopic non-responders, responders were older (43.4 vs 34.4 years; p = 0.001) and had lower EREFS (4.4 ± 1.6 vs. 6.3 ± 1.5; p < 0.001) at baseline. EREFS responders required fewer dilations on their initial post-treatment endoscopy (65% vs 90%; p = 0.002) and had greater symptom (92% vs 64%; p = 0.005) and histologic responses (82% vs 24% <15 eos/hpf; p < 0.001). Over the median follow-up time of 1106 days, EREFS responders required fewer dilations than non-responders (4.5 ± 2.9 vs 6.2 ± 4.5; p = 0.03). Endoscopic responders to tCS required fewer esophageal dilations compared to non-responders. Responders also had better symptom and histologic responses. These results provide evidence that endoscopic response is associated with important clinical outcomes including a reduction in future esophageal dilations.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence patterns following neoadjuvant chemotherapy combined with immunotherapy for esophageal squamous cell carcinoma.","authors":"Miao Wang, Xinyi Wang, Zhourong Liu, Haixia Shen, Baojia Qi, Min Fang, Jin Wang, Yongling Ji, Jian Zeng","doi":"10.1093/dote/doaf034","DOIUrl":"https://doi.org/10.1093/dote/doaf034","url":null,"abstract":"<p><p>This study aims to examine the recurrence patterns in patients with locally advanced esophageal squamous cell carcinoma who underwent surgery following neoadjuvant chemotherapy combined with immunotherapy. Retrospective analysis of patients with esophageal squamous cell carcinoma who received neoadjuvant Chemo-IO before surgery at Zhejiang Cancer Hospital between 2019 and 2023. The clinicopathological features, recurrence patterns, overall survival (OS), and disease-free survival (DFS) were analyzed, and the impact of postoperative adjuvant radiotherapy on prognosis was evaluated. In total, 422 patients were included in the study. After a median follow-up of 22 months, disease recurrence was observed in 89 (21.1%) patients, comprising 37 cases (8.8%) of locoregional recurrence, 30 cases (7.1%) of distant metastasis, and 22 cases (5.2%) of combined recurrence. Patients who achieved a pathologic complete response demonstrated significantly higher 3-year OS rates (90.0% vs. 72.5%; P = 0.01) and DFS rates (73.2% vs. 61.8%; P = 0.046). Univariable and multivariable analyses identified pathological lymph node staging (ypN0 vs. ypN+; HR: 1.73; 95% CI: 1.01-2.99; P = 0.047) as an independent prognostic factor for locoregional recurrence. Kaplan-Meier curves for OS and DFS demonstrated that postoperative radiotherapy (PORT) significantly improved OS and DFS in ypN+ patients after propensity score matching. Additionally, PORT significantly enhanced locoregional recurrence-free survival and distant recurrence-free survival in ypN+ patients. In patients receiving neoadjuvant Chemo-IO, locoregional recurrence is the predominant recurrence pattern. For ypN+ patients, PORT significantly improved survival outcomes. However, long-term outcomes require further investigation through randomized controlled trials.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095849","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}