Diseases of the Esophagus最新文献

{"title":"Evaluating the impact of enhanced recovery after surgery protocols following oesophagectomy: a systematic review and meta-analysis of randomised clinical trials.","authors":"Patrick Kennelly, Matthew G Davey, Diana Griniouk, Gavin Calpin, Noel E Donlon","doi":"10.1093/dote/doae118","DOIUrl":"10.1093/dote/doae118","url":null,"abstract":"<p><p>Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care improvement pathways which are perceived to expedite patient recovery following surgery. Their utility in the setting of oesophagectomy remains unclear. The aim of this study was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on recovery following oesophagectomy compared to standard care. A systematic review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Meta-analysis was performed using Review Manager (Version 5.4). Six RCTs including 850 patients were included in this meta-analysis. Overall complication rate (Odds Ratio (OR): 0.35, Confidence Interval (CI): 0.21, 0.59, P < 0.0001), pulmonary complications (OR: 0.40, CI: 0.24, 0.67, P = 0.0005), post-operative length of stay (LOS) (OR -1.88, CI -2.05, -1.70, P < 0.00001) and time to post-operative flatus (OR: -5.20, CI: -9.46, -0.95, P = 0.02) favoured the ERAS group. There was no difference noted for anastomotic leak (OR: 0.55, CI: 0.24, 1.28, P = 0.17), cardiac complications (OR: 0.86, CI: 0.30, 2.46, P = 0.78), gastrointestinal complications (OR: 0.51, CI: 0.23, 1.17, P = 0.11), wound complications (OR: 0.85, CI: 0.28, 2.58, P = 0.78), mortality (OR: 1.37, CI: 0.26, 7.4, P = 0.71), and 30-day re-admission rate (OR: 1.29, CI: 0.30, 5.47, P = 0.73) between ERAS and standard care groups. ERAS implementation improved post-operative complications, LOS, and time to flatus following oesphagectomy. These results support the robust adoption of ERAS in patients indicated to undergo oesphagectomy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958848","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":"Perioperative morbidity after primary hiatal hernia repair increases as hernia size increases.","authors":"Andrés R Latorre-Rodríguez, Ajay Rajan, Sumeet K Mittal","doi":"10.1093/dote/doae117","DOIUrl":"10.1093/dote/doae117","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive hiatal hernia (HH) repair is the gold standard for correcting mechanical defects of the crural diaphragm due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including HH size, may negatively affect the postoperative course. We sought to determine if an increase in HH size was associated with an increased risk of perioperative complications, ICU admission, or hospital readmissions after minimally invasive HH repair.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of patients who underwent primary HH repair by an experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the percentage of stomach at the thorax determined during surgery (small-HH: <25%, moderate-HH: 25-49%, large-HH: 50-74%, and intrathoracic stomach [ITS]: ≥75%). Covariates were compared between the groups, and logistic regressions were performed to identify factors associated with postoperative morbidity.</p><p><strong>Results: </strong>A total of 391 patients (73.7% female; mean age, 64.4 ± 12.5 years) comprised the groups: small-HH (n = 160), moderate-HH (n = 63), large-HH (n = 64), and ITS (n = 104). Patients with ITS were older (p < 0.001), had longer operations (p < 0.001), greater blood loss (p < 0.001), longer hospital stays (p < 0.001), and an increased risk of early postoperative complications (aOR 2.59 [CI95: 1.28-5.25], p = 0.009) and ICU admission (aOR 13.3 [CI95: 3.10-57.06], p < 0.001).</p><p><strong>Conclusion: </strong>An increase in HH size was associated with an increased risk of early postoperative complications, ICU admission, and a trend toward higher 30- and 90-day hospital readmissions, likely due to the progressive nature of the disease.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900114","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":"Factors influencing the cost-effectiveness of radiofrequency ablation for Barrett's esophagus with low-grade dysplasia in Australia.","authors":"Lauren Caush, Jody Church, Stephen Goodall, Reginald V Lord","doi":"10.1093/dote/doae095","DOIUrl":"10.1093/dote/doae095","url":null,"abstract":"<p><p>Endoscopic eradication therapy using radiofrequency ablation (RFA) is considered an acceptable alternative to surveillance monitoring for Barrett's esophagus with low-grade dysplasia (LGD). This study aimed to estimate whether RFA for LGD is cost-effective and to determine which factors influence cost-effectiveness. A Markov model was developed to estimate the incremental cost per quality-adjusted life year (QALY) gained for RFA compared with endoscopic surveillance. An Australian longitudinal cohort study (PROBE-NET) provides the basis of the model. Replacing surveillance with RFA yields 10 fewer cases of HGD and 9 fewer esophageal adenocarcinoma (EAC)-related deaths per 1000 patients' treatment, given on average 0.192 QALYs at an additional cost of AU$9211 (€5689; US$6262) per patient (incremental cost-effectiveness ratio AU$47,815 per QALY). The model is sensitive to the rate of EAC from LGD health state, the utility values, and the number of RFA sessions. Hence, the incremental benefit ranges from 0.080 QALYs to 0.198 QALYs leading to uncertainty in the cost-effectiveness estimates. When the cancerous progression rate of LGD falls <0.47% per annum, the cost-effectiveness of RFA becomes questionable. RFA treatment of LGD provides significantly better clinical outcomes than surveillance. The additional cost of RFA is acceptable if the LGD to EAC rate is >0.47% per annum and no more than three RFA treatment sessions are provided. Accurate estimates of the risk of developing EAC in patients with LGD are needed to validate the analyses.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585352","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":"Immunonutrition to improve the quality of life of upper gastrointestinal cancer patients undergoing neoadjuvant treatment prior to surgery (NEOIMMUNE): double-blind randomized controlled multicenter clinical trial.","authors":"Sheraz Markar, Christophe Mariette, Frank Bonnetain, Lars Lundell, Riccardo Rosati, Giovanni de Manzoni, Luigi Bonavina, Olga Tucker, Patrick Plum, Xavier Benoit D'Journo, Daniel Van Daele, Geoff Cogill, Stefano Santi, Leandres Farran, Vega Iranzo, Manuel Pera, Julie Veziant, Guillaume Piessen","doi":"10.1093/dote/doae113","DOIUrl":"https://doi.org/10.1093/dote/doae113","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment.</p><p><strong>Methods: </strong>A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 ≥ years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed.</p><p><strong>Results: </strong>The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 ± 18.6 [IMPACT] vs. 55.9 ± 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response.</p><p><strong>Conclusion: </strong>The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042517","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":"Segmental overlap is common in eosinophilic gastrointestinal diseases and impacts clinical presentation and treatment.","authors":"Corey J Ketchem, Elizabeth T Jensen, Xiangfeng Dai, Chelsea Anderson, Ellyn Kodroff, Mary Jo Strobel, Amy Zicarelli, Sarah Gray, Amanda Cordell, Girish Hiremath, Evan S Dellon","doi":"10.1093/dote/doaf011","DOIUrl":"10.1093/dote/doaf011","url":null,"abstract":"<p><p>Little is known about the extent or importance of overlapping gastrointestinal (GI) tract involvement in eosinophilic gastrointestinal diseases (EGIDs), how presentations differ by areas of involvement, and whether overlap impacts treatments. We aimed to evaluate overlapping GI tract involvement in EGIDs and whether clinical differences existed. To do this, we assessed the EGID Partners cohort, an online patient-centered research network. Adults (≥18 years) and caregivers of children <18 years old with EoE or non-EoE EGIDs could join. Surveys were completed at enrollment, comparing patients with EoE alone, EGID without esophageal involvement ('EGID-NE'), and EGID with esophageal involvement ('EGID-WE'). Of 527 cases enrolled, 402 had EoE alone and 125 had non-EoE EGID, 57 (46%) with EGID-NE, and 68 (53%) with EGID-WE. There were 10, 18, and 9 with eosinophilic gastritis, gastroenteritis, and colitis alone, respectively; 88 had overlap. EGID-NE had a higher proportion of females (79%; P < 0.001), and family history of EoE/EGID was more common in EGID-WE (19% vs. 11% in EoE and 7% in EGID-NE; P = 0.007). Patient-Reported Outcomes Measurement Information System measures for anxiety were above general population averages and highest for EGID-WE. Treatments such as elemental formula (47% vs. 32% vs. 20%; P = 0.001), systemic steroids (33% vs. 56% vs. 14%; P < 0.001), and biologics were also more common in EGID-WE and EGID-NE. In conclusion, overlap in regions with eosinophilic infiltration is common for non-EoE EGIDs, with more than half of non-EoE EGIDs having esophageal involvement and a high proportion of multisegmental involvement. EGID-WE patients tended to have more disease burden.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558800","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":"Measuring and quantifying the effects of pyloric dilatation in patients with delayed emptying of the gastric conduit after Ivor-Lewis esophagectomy using EndoFlip™.","authors":"Stefanie Brunner, Florian Lorenz, Thomas Dratsch, Dolores T Krauss, Jennifer A Eckhoff, Lorenz Schröder, Gabriel Allo, Jin-On Jung, Philipp Kasper, Hans F Fuchs, Wolfgang Schroeder, Christiane J Bruns, Tobias Goeser, Seung-Hun Chon","doi":"10.1093/dote/doae104","DOIUrl":"10.1093/dote/doae104","url":null,"abstract":"<p><p>The most common functional challenge after Ivor-Lewis esophagectomy is delayed emptying of the gastric conduit. One of the primary endoscopic treatment strategies is performing a pyloric dilatation. However, the effects of dilation have never been scientifically proven. A novel method to detect pyloric distensibility (DI) is the endoluminal functional lumen imaging probe (EndoFlip™). The purpose of this study is to analyze the effects of pyloric dilatation using an EndoFlip™ measurement. Forty-nine patients after Ivor-Lewis esophagectomy were included retrospectively from June 2021 to August 2023 at University Hospital Cologne, Germany. All patients suffered from early delayed emptying of the gastric conduit (DGCE). DI was measured before and after endoscopic dilatation using EndoFlip™ at 40, 45, and 50 mL balloon filling. The Student's t-test and Chi-Squared test were used. All tests were two-sided, with statistical significance set at P ≤ 0.05. EndoFlip™ measurement and pyloric dilatation were feasible in all patients and no adverse events were recorded. DI proved to be smaller in patients before dilatation compared to patients after dilatation. For 40, 45, and 50 mL balloon filling, the mean DI was 5.0 versus 10.0, 4.5 versus 9.1, and 4.0 and 7.5 mm2/mmHg before versus after dilatation. The differences were significant in all balloon fillings. Endoscopic dilatation of the pylorus is the primary endoscopic treatment strategy in patients suffering from DGCE. Currently, the success of dilatation can only be measured with clinical data. This study could demonstrate that EndoFlip™ can be used as an additional diagnostic tool to rate the success of pyloric dilatation.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830450","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":"Letter to the editor: safety and efficacy of EsoFLIP dilation in patients with esophageal dysmotility: a systematic review.","authors":"Anh D Nguyen, Vani J A Konda","doi":"10.1093/dote/doae094","DOIUrl":"10.1093/dote/doae094","url":null,"abstract":"","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512960","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 strategy involving docetaxel plus cisplatin and 5-fluorouracil followed by conversion surgery for locally advanced unresectable/borderline resectable esophageal squamous cell carcinoma.","authors":"Shota Igaue, Ryoko Nozaki, Daichi Utsunomiya, Yuto Kubo, Kentaro Kubo, Daisuke Kurita, Shun Yamamoto, Mototaka Miyake, Koshiro Ishiyama, Junya Oguma, Ken Kato, Hiroyuki Daiko","doi":"10.1093/dote/doae114","DOIUrl":"https://doi.org/10.1093/dote/doae114","url":null,"abstract":"<p><p>Definitive chemoradiotherapy (dCRT) is the standard treatment for unresectable (T4) esophageal squamous cell carcinoma (ESCC), but the prognosis is poor. Borderline resectable (T3br) ESCC has been discussed, but its clinical features and appropriate treatment are unclear. The effects of docetaxel plus cisplatin and 5-fluorouracil (DCF) therapy and subsequent surgery for potentially unresectable ESCC remain controversial. This was a single-center retrospective cohort study. Patients with T3 or deeper ESCC lesions between January 2017 and June 2020 were examined. We identified T3br/T4 ESCC patients who initially received DCF therapy or dCRT, and analyzed the long-term outcomes of these patients. Seventy-four patients with T3br/T4 ESCC were identified. Forty-four patients initially received DCF therapy, while thirty initially received dCRT. The 3-year overall survival of T3br/T4 patients in the DCF group was better than that in the dCRT group (62.9% vs. 34.1%, P = 0.001). In the T3br cohort, 95.8% of patients underwent surgery after DCF therapy, with an R0 resection rate of 78.3%. In the T4 group, 40% of patients underwent surgery after DCF, with a 75.0% R0 resection rate. No cases of reoperation or in-hospital death occurred. For both subgroups, T3br and T4, the prognosis tended to be better in the DCF group than in the dCRT group. This study explored real-world data from T3br/T4 ESCC patients who initially received DCF and subsequent surgery and revealed that DCF is a promising treatment strategy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016280","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 yield of esophagogastroduodenoscopy and pH-impedance testing in esophageal atresia patients performed according to international guidelines.","authors":"M van Lennep, C Mussies, M A Benninga, R R Gorter, U Krishnan, M P van Wijk","doi":"10.1093/dote/doaf022","DOIUrl":"10.1093/dote/doaf022","url":null,"abstract":"<p><p>According to the European Society for Paediatric Gastroenterology Hepatology And Nutrition & North American Society For Pediatric Gastroenterology, Hepatology And Nutrition (ESPGHAN-NASPGHAN) guideline, esophageal atresia (EA) patients should routinely undergo esophagogastroduodenoscopy (EGD) with biopsies and/or pH-impedance (pH multichannel intraluminal impedance test; pH-MII) for surveillance purposes. It is additionally recommended to perform these procedures when there is a clinical indication: symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. The aim of this study was to evaluate how often EGD/pH-MII outcomes change management decisions in EA children who come for surveillance and/or for clinical evaluation of their symptoms. A retrospective chart review was conducted of all EA patients who received EGD and/or pH-MII for routine surveillance or because of clinical indication, i.e. symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. For each procedure, we assessed whether outcomes changed management decisions. Between 2017 and 2020, 41 patients (median age 2.0 [1.0-17.5] years) underwent EGD/pH-MII for surveillance purposes and 64 (3.0 [0.1-15.8] years) for symptom evaluation. Of the 41 patients who underwent surveillance EGD/pH-MII, 18 (43.9%) were asymptomatic when interviewed. Eight of these 18 (44.4%) had results that changed management decisions. In total, 23/41 (56.1%) had results that changed management decisions. Sixty-four patients presented clinically with (a combination of) dysphagia (n = 50; 78.1%), regurgitation (n = 37; 57.8%), heartburn (n = 18; 28.1%), and/or respiratory symptoms that were thought to have a gastrointestinal origin (n = 24; 37.5%). Results changed management decisions in 34/64 (53.1%) patients who presented with symptoms. There is a high clinical yield of EGD and pH-MII testing in EA patients. More than half of the patients, regardless of indication (routine surveillance or symptom evaluation), had EGD and/or pH-MII results that changed management decisions.</p><p><strong>What is known: </strong></p><p><strong>What is new: </strong></p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774994","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":"Minimally invasive resection is associated with decreased occurrence of early delayed gastric conduit emptying after Ivor-Lewis esophagectomy.","authors":"Ingmar F Rompen, Batuhan Yilmazcelik, Nerma Crnovrsanin, Sabine Schiefer, Nicolas Jorek, Marcus Kantowski, Mohammed Al-Saeedi, Christoph W Michalski, Leila Sisic, Thomas Schmidt, Beat P Müller-Stich, Henrik Nienhüser","doi":"10.1093/dote/doaf006","DOIUrl":"https://doi.org/10.1093/dote/doaf006","url":null,"abstract":"<p><p>Early delayed gastric conduit emptying (DGCE) is a frequent complication after Ivor-Lewis esophagectomy (ILE). Despite its relevance, few studies are published using the international consensus criteria. Therefore, we aimed to assess predictors and clinical consequences of DGCE in patients after ILE. This analysis represents a retrospective, single-center cohort study of patients who underwent ILE (2016-2021). DGCE was assessed by the international consensus criteria. Univariable and a multivariable penalized LASSO logistic regression model was applied to identify predictors of DGCE, whereas postoperative outcomes were assessed by group comparisons. The incidence of early DGCE was 15.6% (46/294 included patients). Of all tested preoperatively known and treatment related factors, only minimally invasive surgery was associated with lower odds for the occurrence of DGCE (OR 0.33, 95%CI:0.12-0.77, P = 0.017) when compared to open surgery. When DGCE occurred, the impact on major postoperative morbidity was limited (DGCE 39.1% vs. non-DGCE 33.1%, P = 0.425), especially there were no differences in starting adjuvant treatment (DGCE 50% vs. non-DGCE 46%; P = 0.615) or overall survival (Log-Rank P = 0.995). The results of this study suggest that the impact of DGCE might have been overestimated in the past. The only factor found to be significantly associated with decreased DGCE was minimally invasive surgery. Therefore, individual patient selection for preventive interventions is difficult and routine preventive interventions only seem justified when they can be performed with low adverse outcomes and at low cost. Higher evidence from randomized controlled trials is needed to assess the optimal strategy to prevent and treat DGCE.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469992","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}