Diseases of the Esophagus最新文献

{"title":"Minimally invasive salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer.","authors":"Shigeru Tsunoda, Tatsuto Nishigori, Shintaro Okumura, Shigeo Hisamori, Keiko Kasahara, Takashi Sakamoto, Tomonori Morimoto, Hiromitsu Kinoshita, Kazutaka Obama","doi":"10.1093/dote/doag026","DOIUrl":"https://doi.org/10.1093/dote/doag026","url":null,"abstract":"<p><p>Salvage esophagectomy is the only remaining treatment option for the potentially curative treatment of residual or recurrent esophageal cancer in patients who underwent definitive chemoradiotherapy (dCRT). However, its postoperative morbidity and mortality have been reported to be high. Although the minimally invasive method has become the preferred approach for nonsalvage esophagectomy because of its reduced surgical trauma and magnified view, its feasibility and oncological results for salvage esophagectomy remain unknown. A retrospective investigation was conducted on 45 patients who had undergone minimally invasive salvage esophagectomy for residual tumors or recurrence after dCRT between 2010 and 2024. There were 38 subtotal esophagectomies and seven total pharyngo-laryngo-esophagectomies. The R0 resection rate was 89%. Severe postoperative morbidity (≥Clavien-Dindo grade III) and overall postoperative morbidity (≥grade II) rates were 11% and 64%, respectively. Anastomotic leakage was found in 10 patients (22%). The rate of anastomotic leakage after dCRT with 60 Gy or more accounted for 31% (9/29), whereas it was 6% (1/16) after dCRT with no more than 50.4 Gy (P = 0.071). There was no 30-day or 90-day mortality. The 3-year overall survival rate and 3-year relapse-free survival (RFS) rates were 74% and 56%, respectively. When compared by pathological nodal status, patients who had positive pathological node metastasis showed considerably poorer RFS (P = 0.003). The 3-year RFS of pathologically node-positive patients was 20% and 69% in node-negative patients. In this article, we will describe the essence of our techniques for safe minimally invasive salvage esophagectomy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500640","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":"Esophageal motor dysfunction in systemic sclerosis: clinical predictors and a risk stratification model.","authors":"Maria Marta Piskorz, Maria Jose Lopez Meiller, Marina Khoury, Natalia Tamborenea, Julieta Morbiducci, Aixa Merce, Tatiana Uehara, Adriana Tevez, Tamara Arias, Esteban Gonzalez Ballerga, Jorge A Olmos","doi":"10.1093/dote/doag031","DOIUrl":"https://doi.org/10.1093/dote/doag031","url":null,"abstract":"<p><strong>Background: </strong>High-resolution esophageal manometry (HRM) allows for precise evaluation of esophageal motor abnormalities in patients with systemic sclerosis (SSc), but data from Latin America are limited. The aim of this study was to determine the prevalence and clinical predictors of esophageal motor dysfunction in patients with SSc, using the Chicago Classification from 2010 to 2022.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study including adult patients with a confirmed diagnosis of SSc who underwent HRM between 2010 and 2022. Studies were performed using Sandhill Scientific (now Diversatek Healthcare) or Medtronic systems and interpreted according to the version of the Chicago Classification available at the time. Esophageal motor function was categorized as absent contractility, ineffective esophageal motility, or normal motility. Demographic, clinical, and serological data were collected from medical records. Logistic regression was used to identify predictors, and a clinical prediction score was developed.</p><p><strong>Results: </strong>Among 127 patients (mean age 56 years, 93% female), 73% had esophageal motor dysfunction. In multivariable analysis, the presence of regurgitation, digital pitting scars, and diffusion capacity for carbon monoxide ≤80% were independently associated with motor dysfunction. A clinical prediction score combining these three factors stratified the probability of esophageal involvement from 40.9% (score 0) to 93.8% (score 3). The model showed good performance in terms of discrimination and calibration.</p><p><strong>Conclusions: </strong>Esophageal motor dysfunction is highly prevalent in patients with SSc and can be predicted using simple clinical variables. This tool may help guide diagnostic evaluation, particularly in healthcare settings with limited access to esophageal manometry.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678494","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":"Short- and long-term outcomes of conversion minimally invasive esophagectomy versus open approach following induction therapy in cT4b esophageal cancer.","authors":"Koshiro Ishiyama, Ryoko Nozaki, Ryota Kakuta, Shota Igaue, Eigo Akimoto, Daichi Utsunomiya, Daisuke Kurita, Yasuyuki Seto, Hiroyuki Daiko","doi":"10.1093/dote/doag025","DOIUrl":"https://doi.org/10.1093/dote/doag025","url":null,"abstract":"<p><p>Conversion surgery (CS) following induction therapy has emerged as a treatment option for patients with cT4b esophageal cancer previously considered unresectable. Minimally invasive approaches, including thoracoscopic and robot-assisted techniques, are increasingly applied in this setting. However, evidence comparing conversion minimally invasive esophagectomy (C-MIE) with conversion open esophagectomy (C-OE) remains limited. This single-center retrospective study included 66 patients with cT4b esophageal cancer who underwent CS after induction therapy between 2007 and 2023. Patients were classified into C-MIE (n = 41) or C-OE (n = 25) groups. Short-term outcomes, including operative time, blood loss, complications, and hospital stay, as well as long-term outcomes such as recurrence and survival, were compared. Prognostic factors were identified using multivariate Cox analysis. The C-MIE group showed markedly reduced intraoperative blood loss (79 vs. 470 mL, P < 0.001), lower incidence of anastomotic leakage (4.8 vs. 24%, P = 0.04), and shorter intensive care unit stay (3 vs. 4 days, P = 0.03) compared with the C-OE group. Three-year overall survival was higher in the C-MIE group (63.0 vs. 39.6%, P = 0.08), although not statistically significant. Multivariate analysis identified Clavien-Dindo grade ≥ IIIa (HR: 3.73, 95% CI: 1.81-7.67, P < 0.001) and ypStage ≥ III (HR: 3.51, 95% CI: 1.6-8.43, P = 0.001) as independent predictors of poorer survival. C-MIE showed a reduced risk but not significantly (HR: 0.79, 95% CI: 0.37-1.66; P = 0.537). C-MIE was associated with acceptable short-term outcomes and comparable long-term oncologic results to C-OE in patients with cT4b esophageal cancer responding to induction therapy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576578","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":"Analysis of reported adverse events with esophageal dilation devices: a 10-year FDA manufacturer and user facility device experience database study.","authors":"Andrew C Stuart, Eric S Tatro, Marc J Zuckerman, Douglas G Adler, Alok K Dwivedi, Sherif E Elhanafi","doi":"10.1093/dote/doag032","DOIUrl":"https://doi.org/10.1093/dote/doag032","url":null,"abstract":"<p><p>Esophageal dilation is a cornerstone therapeutic intervention in managing esophageal narrowing, using various types of dilation devices. While highly effective, it carries risks, including patient-related adverse events (PRAE) and device-related failures (DRF). Analysis of these complications is imperative for decision-making with the goal of enhancing procedural safety. Reports from the Manufacturer and User Facility Device Experience (MAUDE) database from January 2014 to June 2024 were analyzed. Although circulation numbers are unknown, event occurrence per device was compared using weighted averages of events and Poisson regression. A total of 1418 reports were identified, yielding 117 PRAE and 1845 DRF. The overall weighted average of PRAE was 0.07 (95% CI: 0.03, 0.11) per report, while DRF were 1.24 (95% CI: 1.13-1.36) per report. The most common PRAE was perforation (n = 32; 27%), with the most reports attributed to Rigiflex Pneumatic II (n = 13) and Savary-Giliard/American (n = 9). The most common DRFs pertained to material integrity issues which occur at relative rates 2.4 to 3.9 times higher than other device-related complications. About 117 PRAE reports were identified in the entire cohort. After excluding pneumatic dilation cases, it was determined that 70% (n = 71) of all PRAEs co-occurred with a material integrity issue. MAUDE analysis suggests variability in safety profiles across esophageal dilators. Perforation is the most reported PRAE across esophageal dilation procedures in general and may be linked to the co-occurrence of material integrity issues and aberrant guidewires in certain wire-guided polyvinyl dilators. To reduce PRAE occurrences, we encourage operators to recognize these patterns and their potential impact on adverse patient outcomes.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678504","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":"Regional characteristics of esophageal cancer and robot-assisted minimally invasive esophagectomy (RAMIE): an analysis of the international UGIRA registry.","authors":"Yota Suzuki, Inderpal S Sarkaria, Sangmin Kim, Omar Awais, Richard van Hillegersberg, Jelle Ruurda, Yin K Chao, Peter Grimminger, Zhigang Li, Chunguang Li, Chang Yuan, Jens-Peter Hölzen, Mazen A Juratli, Andreas Pascher, Hans F Fuchs, Christiane J Bruns, Luca Bellaio, Vladimir Lozanovski, Takeo Fujita, Marc J van Det, Ewout A Kouwenhoven, Jan W Haveman, Boudewijn van Etten, Suzanne S Gisbertz, Mark I van Berge Henegouwen, Gijs I van Boxel, Jennifer Straatman, Magnus Nilsson, Ioannis Rouvelas, Tom Mala, Dag T Førland, Frank Benedix, Eric Lorenz, Philippe Rouanet, Anne Mourregot, Arul Immanuel, Simone Giacopuzzi, Shaun R Preston, Hiroyuki Daiko, Beat P Müller, Benjamin Babic, Katharina Beyer, Alexander Semaan, Silvia Jarosciakova, Hecheng Li, Paolo Strignano, Guillaume Piessen, Philip W Chiu, Marco Milone, Jan-Hendrik Egberts, Rubens A A Sallum, Giovanni Ferrari, James D Luketich, Evan T Alicuben","doi":"10.1093/dote/doag042","DOIUrl":"https://doi.org/10.1093/dote/doag042","url":null,"abstract":"<p><p>Esophageal cancer is a global burden, and multiple international societies exist to address the issue in international collaboration. This study aims to analyze the characteristics of esophageal cancer and robot-assisted minimally invasive esophagectomy (RAMIE) across geographic areas. We performed a retrospective analysis of the Upper GI International Robotic Association (UGIRA) international database from January 2016 to April 2024. Forty centers worldwide that were known to perform RAMIE were involved in establishing this consortium. The patient characteristics, surgical techniques, and short-term outcomes of RAMIE were compared by each regional area (Europe, Asia, North America, and South America). A total of 3,916 RAMIE cases were registered in the UGIRA database (2,643 in Europe, 1,130 in Asia, 111 in North America, and 32 in South America). The median age was 66 years, and 80.5% of patients were male. Notably, Asia had a high prevalence of squamous cell carcinoma (91.2%) and predominant use of the McKeown approach (94.9%). BMI was lower in Asia, whereas comorbidities were more common in Western countries across all types. The use of neoadjuvant chemotherapy and radiation was lower in Asia (48.2% and 20.8 %, respectively). Postoperative complications also differed by region; pneumonia was most common in Europe and South America, cardiopulmonary complications in North America, and recurrent nerve injury in Asia. In conclusion, regional differences were observed in baseline characteristics, treatment approaches, and complication patterns in patients treated by RAMIE for esophageal cancer. Recognizing these variations is essential for fostering mutual understanding and advancing the field through international collaboration.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789051","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":"Comparison of neoadjuvant chemoimmunotherapy with or without concurrent radiotherapy for locally advanced resectable esophageal squamous cell carcinoma: a multicenter retrospective study.","authors":"Huanghe He, Bing Xu, Hui Liu, Cheng Le, Yaping Zhu, Yangyang Zhang, Sihe Huang, Jun Liu, Jianxing He","doi":"10.1093/dote/doag013","DOIUrl":"https://doi.org/10.1093/dote/doag013","url":null,"abstract":"<p><p>The aim of this study was to evaluate the safety and clinical benefits of adding concurrent radiotherapy to neoadjuvant chemoimmunotherapy in patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). This multicenter retrospective study enrolled eligible ESCC patients treated between November 2019 and July 2020 from four hospitals. Baseline characteristics were collected, and patients were categorized into two groups based on neoadjuvant regimens: the chemoimmunotherapy group (CI group) and the chemoimmunotherapy with concurrent radiotherapy group (CIR group). Treatment-related complications, surgical outcomes, pathological response, tumor recurrence, and survival were analyzed. A total of 78 eligible patients were included: 49 in the CI group and 29 in the CIR group. Baseline characteristics (age, sex, clinical stage, cardiopulmonary function) were balanced between groups. During neoadjuvant therapy, the CI group had significantly lower incidences of grade 3 and grade 4 leukopenia/neutropenia (15/49 vs. 15/29, P = 0.025), and lower incidences of grade 3 and grade 4 checkpoint inhibitor pneumonitis (CIP) (1/49 vs. 8/29, P = 0.002). All CI group patients achieved R0 resection after 1-3 neoadjuvant cycles versus 24/29 in the CIR group (P > 0.05). The CIR group showed higher major pathological response (including pathological complete response) rates (16/24 vs. 10/49), though statistically non-significant (P = 0.121). No significant differences were observed in 5-year progression-free survival or overall survival. Adding concurrent radiotherapy to neoadjuvant chemoimmunotherapy increased hematologic toxicity and CIP in resectable locally advanced ESCC patients, without conferring survival benefits.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789155","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 prevalence, nature and trajectory of oropharyngeal dysphagia within the first year following curative open resection for esophageal cancer.","authors":"Michelle Hayes, Anna Gillman, Jessie A Elliott, Claire L Donohoe, John V Reynolds, Julie Regan","doi":"10.1093/dote/doag029","DOIUrl":"10.1093/dote/doag029","url":null,"abstract":"<p><p>In the absence of a mechanical stricture, oropharyngeal dysphagia following esophageal cancer surgery, and swallowing physiology more broadly, is poorly understood. This study investigated oropharyngeal dysphagia within the first year following curative open esophageal resection. A prospective cohort study was conducted (January 2022 to January 2024) at the National Esophageal Cancer Centre in Ireland. Participants were recruited between 6 to 12 months post-esophagectomy. A standardized videofluoroscopy was completed. Outcome measures included the Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), and Penetration-Aspiration Scale (PAS). Functional Oral Intake Scale (FOIS) was used to identify oral intake status. To evaluate the trajectory of oropharyngeal dysphagia, long-term data were compared to previously published acute data findings. Seventeen participants (12 males; mean age 65 years, range 46-80) were included. The cohort comprised transthoracic (2-stage n = 7, 3-stage n = 3) and transhiatal (n = 7) resections. 11 participants (65%) had persistent oropharyngeal dysphagia (DIGESTv2), and 2 (12%) continued to aspirate greater than 6-months, both of whom had a transhiatal resection. 10 (59%) continued to modify their diet (abnormal FOIS <7). MBSImP revealed impaired initiation of swallow (82%), anterior hyoid excursion (82%), tongue base retraction (100%), pharyngeal residue (100%) and neo-esophageal clearance (82%). When comparing acute to longer term data, there was a statistically significant difference in aspiration based on PAS (P = 0.016), but not dysphagia based on the DIGESTv2 (P = 0.500). Oropharyngeal dysphagia is prevalent within the first year following open esophageal cancer surgery. The study informs the need for structured guidelines and a swallowing care pathway.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678556","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":"Impact of a diagnosis of 'low-grade dysplasia' in patients with Barrett's esophagus.","authors":"Chih-Han Kung, Ravi Vissapragada, Ann Schloithe, Tim Bright, Norma Bulamu, David Watson","doi":"10.1093/dote/doag028","DOIUrl":"10.1093/dote/doag028","url":null,"abstract":"<p><p>Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD)/EAC can be directly from non-dysplastic BE or via low-grade dysplasia (LGD). There is a lack of consensus about the implications of LGD diagnosis on progression risk and whether modifying risk progression with endoscopic interventions such as radiofrequency ablation (RFA) is appropriate. The aim of this study was to determine the clinical implications of LGD and the cost-effectiveness of different management strategies. Outcomes from a large single-center prospective BE surveillance database were retrospectively analyzed. All patients with BE in a structured surveillance program were included. The cohort was divided into three groups: non-dysplastic BE throughout, LGD at surveillance entry, and LGD developing during surveillance. Each group's annual incidence of progression to HGD/EAC was calculated per 100 person-years. Outcomes were then applied within a health economic model for health economic analysis of ongoing endoscopic surveillance versus RFA of LGD to identify the most cost-effective management strategy. Nine hundred fourteen patients were included; 727 had non-dysplastic BE, 97 had LGD at entry, and 90 developed LGD during surveillance. Total surveillance time was 5212 person-years. Forty-six (5.0%) patients progressed to HGD/EAC, at an annual progression rate of 0.9 per 100 person-years. For subgroups, the progression rates to HGD/EAC were 0.6 per 100 person-years for non-dysplastic BE, 1.0 for LGD at entry, and 2.2 for LGD during surveillance (P < 0.0001). The most cost-effective management strategy was RFA if LGD was identified under surveillance, with an estimated cost per quality-adjusted life year gained being AU$26,763. Overall progression from LGD to HGD/EAC was comparable to most previous studies. RFA is a cost-effective management strategy for BE once LGD arises during surveillance.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678479","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":"ISDE guidelines on the management of cT2N0 esophageal cancer.","authors":"Geoffrey P Kohn, Virginia Litle, Yousif Eliya, Samantha Leng, Mohammad Asghari-Jafarabadi, Nicolas Contreras, Andrew Davies, Rudy Lackner, Kimberley S Mak, Tom Mala, Ben Markman, Sarbajit Mukherjee, Christopher Nevala-Plagemann, Elizabeth Smyth, Javed Sultan, Stephanie Worrell, Shun Yamamoto, Bas P L Wijnhoven, Ewen A Griffiths","doi":"10.1093/dote/doag019","DOIUrl":"10.1093/dote/doag019","url":null,"abstract":"<p><p>Esophageal cancer incidence is rising globally, with at least 500,000 new cases diagnosed annually. Management options for non-metastatic disease include primary resection, neoadjuvant or perioperative therapies, or definitive non-surgical treatment, with the choice being guided by tumor staging, histology, patient fitness, and available resources. However, even with the use of advanced diagnostic modalities, preoperative clinical staging is challenging with respect to accuracy of both tumor and nodal assessment. Early-stage esophageal cancer may be managed with local therapies, such as endoscopic mucosal resection or submucosal dissection, while for more advanced tumors managed with curative intent neoadjuvant oncologic therapy is commonly recommended. However, between these two groups lies an infrequent but important subgroup of patients, clinically staged cT2N0M0 esophageal cancer. Guidelines such as the NIH's National Cancer Institute recommends either surgery alone or neoadjuvant therapy followed by surgery for AJCC Stage I cancers, and add the option of definitive chemoradiation for Stage II disease. With cT2N0 disease straddling both AJCC classifications, management guidance is lacking. This guideline will provide an evidence-based recommendation from the International Society For Disease Of The Esophagus on the management of cT2N0 esophageal cancer, of all types. The recommendations are intended to support surgeons, oncologists, and patients in decisions about the best practice preoperative oncologic management of cT2N0M0 esophageal cancer. A Working Group within the International Society for Diseases of the Esophagus (ISDE) Guidelines Committee performed a systematic review of the literature. Results of the systematic review were presented to a panel of experts and these results informed the panel discussion about the guideline. This panel used Grading of Recommendations Assessment, Development, and Evaluation approach to deliberate and formulate recommendations. The panel agreed on a conditional recommendation for the use of neoadjuvant therapy followed by surgery over primary surgical resection (PSR) for adult patients with cT2N0M0 esophageal cancer. Preoperative clinical staging of esophageal cancer is uncertain, with deficiencies in all diagnostic modalities. However, when all modern staging techniques are utilized, the ISDE recommends neoadjuvant therapy followed by surgical resection as the favored treatment of cT2N0 esophageal cancer. Certain patient groups may still be offered PSR, particularly those unable to tolerate neoadjuvant therapies, or those patients with very low risk of lymph node metastasis as suggested by histological features, small tumor size, and other features.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367309","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":"Clinical tips to optimize liquid nitrogen spray cryotherapy in esophageal malignancy.","authors":"Joseph Spataro, Michael Fuchs, Alvin Zfass","doi":"10.1093/dote/doag024","DOIUrl":"10.1093/dote/doag024","url":null,"abstract":"<p><p>Liquid nitrogen spray cryotherapy is an approved modality that has been used to treat esophageal disease for more than 20 years. This versatile tool effectively ablates unwanted tissue; however, its widespread adoption has been limited by procedural complexity limiting technical success. Drawing on the collective experience of the authors, this article provides practical tips to optimize procedure safety, efficiency, and outcomes, with a focus on esophageal malignancy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"39 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476441","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}