Diseases of the Esophagus最新文献

{"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}

{"title":"Efficacy and safety of self-expanding metal stents in advanced esophageal cancer: a 12-year analysis in a referral center.","authors":"Bruno Costa Martins, Julia Mayumi Gregorio, Rafael Utimura Sueta, Déborah Marques Centeno, Pastor Joaquín Ortiz Mendieta, Marcelo Simas de Lima, Renata Nobre Moura, Luciano Lenz, Caterina Maria Pia Simioni Pennacchi, Andressa Abnader Machado, Rubens Antonio Aissar Sallum, Fauze Maluf-Filho","doi":"10.1093/dote/doaf039","DOIUrl":"https://doi.org/10.1093/dote/doaf039","url":null,"abstract":"<p><p>Esophageal cancer is often diagnosed in advanced stages, leading to significant dysphagia and affecting patients' quality of life. This study aims to evaluate the efficacy and safety of self-expanding metallic stents (SEMS) for the palliative treatment of advanced esophageal cancer. This observational study was conducted in a tertiary cancer center, analyzing a prospectively maintained database where those undergoing SEMS placement between January 2009 and January 2021 were analyzed. Technical and clinical success rates, improvement in dysphagia and adverse events were analyzed. A total of 364 patients were included (291 men, mean age 60.8 years). The technical success was 100%, with 88% of patients showing improvement in dysphagia after stent placement. Adverse events occurred in 58% of cases, with stent-induced fistula (14%) and stent migration (9%) being the most common. There was no relationship between stent covering (partially versus fully covered) and adverse events (fistula P = 0.056; migration P = 0.264; in/overgrowth P = 0.825). Median overall survival was 207.2 days, with 1-month and 3-month survival rates of 82% and 66%, respectively. Placement of esophageal SEMS in patients with advanced esophageal tumors has high technical and clinical success rates. It immediately improves dysphagia in most patients. Stent-induced fistula and stent migration are the most common adverse events. Their occurrence is not influenced by previous chemo radiation or the type of stent covering. In most cases, they can be endoscopically managed.</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":"144144329","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":"Clinical outcomes of pembrolizumab plus chemotherapy for postoperative recurrent esophageal squamous cell carcinoma.","authors":"Takahito Sugase, Takashi Kanemura, Norihiro Matsuura, Keijiro Sugimura, Tomohira Takeoka, Yuki Ushimaru, Yasunori Masuike, Yoshitomo Yanagimoto, Ryota Mori, Masatoshi Kitakaze, Masahiko Kubo, Yosuke Mukai, Hisateru Komatsu, Toshinori Sueda, Yoshinori Kagawa, Junichi Nishimura, Hiroshi Wada, Masayoshi Yasui, Hiroshi Miyata","doi":"10.1093/dote/doaf029","DOIUrl":"https://doi.org/10.1093/dote/doaf029","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy combined with chemotherapy has been the first-line treatment for metastatic or unresectable locally advanced esophageal cancer. However, postoperative recurrences have not been sufficiently investigated. We investigated the clinical outcomes of pembrolizumab plus cisplatin plus 5-fluorouracil (CF) therapy for postoperative recurrent esophageal squamous cell carcinoma.</p><p><strong>Methods: </strong>We retrospectively analyzed 100 consecutive patients with postoperative recurrence and compared their treatment response and survival outcomes in response to pembrolizumab plus CF therapy and conventional CF therapy.</p><p><strong>Results: </strong>Pembrolizumab plus CF therapy had higher response and objective response rates (41% vs. 27%, 77% vs. 57%, respectively) and prolonged progression-free survival (median 6.5 vs. 4.9 months, P = 0.011) and overall survival (not reached [NR] vs. 14.0 months, P = 0.087) compared to CF therapy. Early tumor shrinkage (ETS) ≧20% had a longer duration of response with pembrolizumab plus CF therapy compared with conventional CF therapy (NR vs. 10.2 months, P = 0.007). Conversely, the additional benefit of pembrolizumab in CF therapy was limited when ETS was <20% (4.0 vs. 3.4 months, P = 0.814). CF therapy was associated with worse survival outcomes for recurrences within 6 months post-surgery compared to those after 6 months. Pembrolizumab plus CF therapy provided comparable survival outcomes regardless of the timing of recurrence; however, it was less effective in combined positive score < 10 within the first 6 months.</p><p><strong>Conclusion: </strong>First-line pembrolizumab plus chemotherapy for postoperative recurrent esophageal cancer improved clinical outcomes compared to conventional CF therapy and can be expected to be one of the treatment options even in early postoperative recurrence.</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":"144192529","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":"Lack of bidirectional associations between gastroesophageal reflux disease and periodontitis: a systematic review and meta-analysis.","authors":"Fang-Ping Shi, Zhao-Jie Zheng, Yu-Lu Chen","doi":"10.1093/dote/doaf031","DOIUrl":"https://doi.org/10.1093/dote/doaf031","url":null,"abstract":"<p><p>The bidirectional relationship between gastroesophageal reflux disease (GERD) and periodontitis (PD), particularly the temporal directionality, remains unclear. A systematic review and meta-analysis were conducted to evaluate bidirectional associations between GERD and PD. Three databases (PubMed, Embase, and Cochrane Library) were systematically searched from inception to December 1, 2024. Risk estimates from individual studies were pooled using random-effects models. Five studies assessed the risk of PD in patients with GERD, while three studies evaluated the risk of GERD in patients with PD. The overall analysis suggested an increased risk of PD among patients with GERD (odds ratio [OR] = 1.27; 95% confidence interval [CI]: 1.02-1.57; p = 0.029; I2 = 96.5%). However, sensitivity analyses, limited to cohort studies (OR = 1.15; 95% CI: 0.93-1.42; P = 0.05; I2 = 96.9%) and subgroup analyses, did not support this finding. Similarly, PD patients did not exhibit a higher risk of GERD (OR = 1.19; 95% CI: 0.90-1.57; P = 0.223; I2 = 94.3%). The present study could not confirm any bidirectional associations between GERD and PD. Further high-quality longitudinal studies are required to validate these findings.</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":"144009803","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":"Tribute to Ikuo.","authors":"Nirmala Gonsalves, John Pandolfino, David Katzka","doi":"10.1093/dote/doaf014","DOIUrl":"https://doi.org/10.1093/dote/doaf014","url":null,"abstract":"","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607035","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":"Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review.","authors":"Andreas Weise Mucha, Rune Broni Strandby, Nikolaj Albeck Nerup, Michael Patrick Achiam","doi":"10.1093/dote/doaf016","DOIUrl":"10.1093/dote/doaf016","url":null,"abstract":"<p><p>Anastomotic leakage (AL) is a significant complication following esophagectomy. AL affects 8%-17% of patients and is associated with increased morbidity, mortality, and hospital stay. To this date, no consensus exists on the most optimal treatment. This systematic review aimed to determine the most effective treatment approach. A systematic search of Medline, Web of Science, Cochrane, Scopus, and Embase databases was conducted. Only studies reporting on the treatment of intrathoracic anastomotic leakage after esophagectomy with gastric conduit reconstruction for cancer were included. Studies investigating other esophageal disorders or failing to report the location of the anastomosis were excluded. The methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale for cohort studies. Out of 12,966 identified studies, 38 were included for analysis after removing duplicates and screening titles, abstracts, and full texts. Of these, five were found to be of poor methodological quality and 33 were of moderate quality. The most researched treatment methods were Endoluminal vacuum therapy (EVT), naso-fistula tube drainage (NFTD), and stent treatment. The success and mortality rates for EVT were 82% and 10.7%, for NFTD, 94% and 5.2%, and, for stent treatment, 75.1% and 13.5%, respectively. AL can be effectively treated with EVT, stent treatment, and NFTD. The NFTD approach appeared to have a higher success rate and lower mortality than other treatment modalities. However, it requires a longer treatment duration. Due to limitations within the included studies, a definitive recommendation regarding the optimal treatment for AL cannot be made.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573782","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":"Associations between body mass index and gastroesophageal cancer incidence and mortality: novel insights from a nationwide registry-based cohort study.","authors":"Usman Saeed, Tor Åge Myklebust, Trude Eid Robsahm, Dagfinn Aune, Bjørn Møller, Bjørn Steen Skålhegg, Sheraz Yaqub, Tom Mala","doi":"10.1093/dote/doaf018","DOIUrl":"10.1093/dote/doaf018","url":null,"abstract":"<p><p>The association between body mass index (BMI) and cancers of the esophagus and the stomach remains complex and requires further exploration. This study aimed to investigate this association, including early-onset (< 50 years) cancer and cancer related mortality. A nationwide registry-based cohort study was performed by linking data from multiple national registries in Norway. The cohort included 1,723,692 individuals, with 22,473 gastroesophageal cancer cases identified over 55,701,169 person-years of follow-up. In men, a 5 kg/m2 increase in BMI was associated with an increased risk of esophageal (HR 1.34, 95%CI 1.22-1.48) and cardia adenocarcinoma (HR 1.36, 95% CI, 1.22-1.50). This finding extended to individuals with high BMI in early life (16-29 years) for esophageal adenocarcinoma. The highest risk per 5 kg/m2 increase in BMI was observed for early-onset esophageal (HR 2.49, 95%CI 1.23-5.02) and cardia adenocarcinoma (HR 2.26, 95%CI 1.19-4.27). Among women, increased BMI was associated with a higher risk of both esophageal (HR 1.28, 95%CI 1.13-1.44) and gastric adenocarcinoma (HR 1.04, 95%CI 1.01-1.07). Women with elevated BMI in early life also demonstrated increased risk for these cancers. In both sexes, a 5 kg/m2 increase in BMI was inversely associated with squamous cell carcinoma of the esophagus. No association was observed between BMI and risk of cancer-related mortality. This study highlights an elevated risk of gastroesophageal adenocarcinomas with increasing BMI, with notable sex, age, and site-specific variations. The findings also point to a heightened risk of early-onset esophageal and cardia adenocarcinoma in men with high BMI.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651839","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":"Reliability of symptoms for diagnosis and sling fiber preservation for prevention of GERD after POEM: is there a problem?","authors":"Zaheer Nabi, D Nageshwar Reddy","doi":"10.1093/dote/doaf015","DOIUrl":"https://doi.org/10.1093/dote/doaf015","url":null,"abstract":"","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558802","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":"Robotic- assisted minimally invasive Ivor-Lewis handsewn anastomosis technique and outcomes from a large-volume European centre.","authors":"Annalisa Y L Ng, Lucas Goense, Sylvia Van De Horst, Jan Willem Van Den Berg, Jelle P Ruurda, Richard Van Hillegersberg","doi":"10.1093/dote/doaf019","DOIUrl":"10.1093/dote/doaf019","url":null,"abstract":"<p><p>In minimally invasive transthoracic esophagectomy, intrathoracic anastomoses are usually performed with stapling devices to avoid a technically challenging handsewn technique in the upper mediastinum. Few have published about handsewn anastomotic techniques due to the technically demanding requirements for suturing with rigid instruments in the thoracic cavity. With robot-assisted minimally invasive esophagectomy (RAMIE), the robot provides increased dexterity, enabling construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of our technique for hand-sewn intrathoracic anastomosis in RAMIE, following the initial learning phase between 2016 and 2018 in UMC Utrecht. Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis were included in this retrospective study. Data were extracted from a prospectively maintained institutional database. Key technique steps included esophageal stay-sutures, use of barbed sutures for the anastomosis, placement of tension-releasing stitches, and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage; secondary outcomes included anastomotic stricture rate and duration of anastomosis construction. Between 1 November 2019 and 30 May 2023, 89 consecutive patients were included. Anastomotic leakage (defined by the Esophageal Complications Consensus Group) occurred in 11 patients (12.4%), which involved a grade I leak in four patients (4.5%), grade II leak in one patient (1.1%), and grade III leakage in six patients (6.7%). The median duration of anastomosis creation was 33 minutes (range, 23-55 minutes). Stricture rate was 32.6% (29 patients) at 1 year post-operatively for which dilation was needed for all patients. This study shows that a robot-assisted hand-sewn intrathoracic anastomosis in RAMIE is feasible, safe, and reliable.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659598","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}