Diseases of the Esophagus最新文献

{"title":"Is prophylactic lymph node dissection efficacious in salvage esophagectomy after definitive chemoradiotherapy?","authors":"Kengo Kuriyama, Akihiko Okamura, Masaru Hayami, Jun Kanamori, Masahiro Tamura, Naoki Takahashi, Masayoshi Terayama, Yasukazu Kanie, Suguru Maruyama, Masayuki Watanabe","doi":"10.1093/dote/doaf004","DOIUrl":"https://doi.org/10.1093/dote/doaf004","url":null,"abstract":"<p><strong>Background: </strong>Salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy (dCRT) is a high-risk surgery, and radical lymph node dissection (RLND) can cause severe complications. However, the significance of RLND in salvage surgery remains unclear.</p><p><strong>Methods: </strong>This study included 55 patients who underwent curative-intent salvage esophagectomy after dCRT for esophageal squamous cell carcinoma. We evaluated the prognostic impact of lymph node dissection of each station using efficacy indexes (EIs) and compared the outcomes between RLND and limited lymph node dissection (LLND).</p><p><strong>Results: </strong>Nine (16.4%) patients underwent RLND and 46 (83.6%) underwent LLND. Patients who underwent RLND had greater operative blood loss and a greater number of resected lymph nodes compared to patients who underwent LLND (P = 0.053 and 0.002, respectively). However, the incidence of postoperative complications was not significantly different between the groups. The EIs of the cervical and mediastinal lymph nodes were zero because no patients with involved nodes at these stations remained alive at 5 years. In contrast, perigastric lymph nodes had relatively high EIs. Overall and cancer-specific survival did not differ significantly between patients who underwent RLND and those who underwent LLND (P = 0.475 and 0.808, respectively).</p><p><strong>Conclusions: </strong>The EIs of the cervical and mediastinal lymph nodes were zero, and RLND did not improve survival. Depending on tumor status, LLND may be sufficient for salvage esophagectomy.</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":"143450969","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 oesophageal and laryngo-pharyngeal symptoms of reflux in patients diagnosed with SIBO and IMO with antibiotics.","authors":"Swathikan Chidambaram, Sue Steven, Sheraz R Markar, Nick Boyle","doi":"10.1093/dote/doaf001","DOIUrl":"10.1093/dote/doaf001","url":null,"abstract":"<p><p>Gastro-oesophageal reflux disease (GERD) may present with esophageal and/or extra-oesophageal, laryngo-pharyngeal (LPR) symptoms including cough, throat clearing and dysphonia. A definitive diagnosis can be challenging, and existing treatments are often ineffective in resolving them. Oesophageal symptoms thought to be caused by GERD can overlap with those from functional dyspepsia (FD) and previous studies have proposed intestinal dysbiosis such as small intestinal bacteria overgrowth (SIBO) and intestinal methogenic overgrowth (IMO) as potential causes. This study aims to establish the relationship between SIBO/IMO and LPR symptoms, and if their treatment improves LPR symptoms. We performed a retrospective cohort study of patients with SIBO or IMO in a high-volume, tertiary referral center for anti-reflux procedures between 2018 and 2023. The primary outcome measures were GERD-HQRL and LPR/RSI scores after treatment for SIBO/IMO, and anti-reflux medication use. Twenty-three patients were eligible. The mean decrease in GERD-HQRL score was 11.8 (3.31) (P = 0.0017). The mean decrease in RSI score was 8.57 (1.97) (P = 0.0003). In patients with raised DeMeester scores, the GERD-HQRL scores improved by 17.2 (5.02) (P = 0.009) and RSI scores by 9.33 (3.60) (P = 0.03). The symptom association probability was highest at 72.7% (n = 8) for belching; followed by 80% for heartburn (n = 4) and 66.7% for regurgitation (n = 4). The use of PPIs decreased in 95% (n = 19) of patients; 18 had stopped PPIs completely. All patients avoided potential surgical interventions. The diagnosis and treatment of SIBO in patients with atypical reflux symptoms may prevent unnecessary surgical and pharmacological treatments. Further prospective work is required to confirm this.</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":"143774996","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":"Gastric conduit in patients with previous endoscopic resection of the stomach for esophageal squamous cell carcinoma.","authors":"Yelee Kwon, Jae Kwang Yun, Geun Dong Lee, Se Hoon Choi, Yong-Hee Kim, Hyeong Ryul Kim","doi":"10.1093/dote/doae112","DOIUrl":"10.1093/dote/doae112","url":null,"abstract":"<p><p>This study investigated the clinical outcomes of gastric conduits for esophageal reconstruction in esophageal squamous cell carcinoma (ESCC) patients who had previously undergone endoscopic resection of the stomach. From January 2006 to April 2023, a total of 1964 patients underwent surgery for esophageal cancer at our institution. After initially excluding 125 of these cases due to a histology other than ESCC, we identified 147 patients in the remaining population who had previously undergone a gastric endoscopic resection, among which 56 patients (67.0 ± 6.5 years) were included in the present study cohort. A gastric conduit event was defined as any new lesions at the gastric conduit. The diagnoses of a previous gastric lesion included early gastric cancer (EGC) in 32 patients (57.1%), adenoma in 23 patients (41.1%), and dysplasia in 1 (1.8%) patient. The endoscopic procedures involved an endoscopic submucosal dissection (ESD) in 36 patients (64.3%) and an endoscopic mucosal resection in 20 patients (35.7%). The 10-year event-free survival rate for the gastric conduit was 43.7%. Five patients were diagnosed with metachronous gastric neoplasm (EGC in two and adenoma in three patients). Endoscopic procedures were available for all five cases, but one patient with a metachronous EGC required a colon interposition with a total gastrectomy. In ESCC patients who have undergone an endoscopic resection of their gastric lesions, subsequent esophageal reconstruction with a gastric conduit could be a viable option if followed by regular endoscopic surveillance for the early detection and endoscopic curability of any lesions.</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":"142807365","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":"Comparing the efficacy of different proton pump inhibitor dosing regimens for the treatment of gastroesophageal reflux disease: a systematic review and meta-analysis.","authors":"Tyra Nguyen, Katherine Barnhill, Alex Zhornitskiy, Kyung Sang Yu, Garth Fuller, Katherine Makaroff, Brennan M R Spiegel, Gillian Gresham, Christopher V Almario","doi":"10.1093/dote/doae109","DOIUrl":"10.1093/dote/doae109","url":null,"abstract":"<p><p>Several proton pump inhibitor (PPI) dosing regimens that vary by strength and frequency (once [Qday] or twice [BID] daily) are available to treat gastroesophageal reflux disease (GERD). We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of various PPI regimens on esophageal healing and GERD and heartburn symptoms. To identify relevant studies, we searched EMBASE and PubMed in January 2023, which yielded 1381 records. Eligible RCTs included those that enrolled adults diagnosed with GERD and compared different dosing regimens within the same PPI. The outcomes were esophageal healing and resolution of GERD and heartburn symptoms within 12 weeks (i.e. short-term) and > 12 weeks (i.e. long-term). Meta-analysis pooling of the odds ratios with 95% confidence intervals were estimated using the random-effects inverse-variance model. Overall, a total of 38 RCTs across 20 countries (N = 15,540 patients, mean age 50 years, 55% male) were included. Most PPI trials compared half standard dose Qday versus standard dose Qday or standard dose Qday versus double standard dose Qday. In general, when considering daily dosing, higher PPI strength significantly improved esophageal healing and relief of GERD symptoms both in the short- and long-term. Fewer trials compared Qday versus BID dosing; the impact of BID dosing on outcomes was inconsistent across the different PPI strength comparisons. In conclusion, this meta-analysis revealed that increasing PPI Qday dosages led to improved GERD outcomes. However, few studies compared Qday to BID dosing; as twice daily PPI usage is common in clinical practice, further studies are warranted to determine whether such dosing improves clinical outcomes.</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":"142824605","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 enigma of the perfect gastric conduit-invited editorial.","authors":"Leeying Giet, James Gossage","doi":"10.1093/dote/doae092","DOIUrl":"10.1093/dote/doae092","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":"142480737","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":"Managing esophageal squamous cell carcinoma after cervical radiotherapy for a head and neck cancer: esophagectomy remains a viable option.","authors":"Chia Liu, Tien-Li Lan, Ping-Chung Tsai, Ling-I Chien, Chien-Sheng Huang, Pin-I Huang, Po-Kuei Hsu","doi":"10.1093/dote/doae099","DOIUrl":"10.1093/dote/doae099","url":null,"abstract":"<p><p>Managing esophageal squamous cell carcinoma (ESCC) in patients with a history of cervical radiotherapy for a head and neck cancer (HNC) often requires a careful evaluation of esophagectomy due to concerns regarding complications and prognosis. This study evaluates the periesophagectomy and oncological outcomes of such patients. Patients diagnosed with ESCC between January 2010 and August 2023 and who had undergone esophagectomy with cervical anastomosis were retrospectively reviewed. Patients were categorized into two groups based on the presence (group 1) or absence (group 2) of a history of radiotherapy for as HNC. After 1: 2 propensity score matching, the perioperative and oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS), were evaluated. A total of 481 patients, 32 in group 1 and 449 in group 2, were included. After matching, group 1 patients and 64 patients in the group 2 were analyzed. All the patients in group 1 were males, and their mean age was 56 years. The median radiation dose was 69 Gy. The rates of anastomosis leakage, pneumonia, respiratory failure, and reoperation were comparable between the two groups. However, vocal cord palsy occurred more frequently in group 1, particularly in those with recurrent laryngeal nerve lymph node dissection (37.5%). The 3-year OS (69.6% vs. 75.2%; p = 0.26) and RFS (50.8% vs. 55.9%; p = 0.63) were similar between groups 1 and 2. In conclusion, perioperative and oncological outcomes were comparable between ESCC patients with and without prior HNC radiotherapy, supporting esophagectomy as a feasible option.</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":"142607417","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":"Optimal extent of left recurrent laryngeal nerve para-lymph node dissection in esophageal squamous cell carcinoma: a retrospective analysis based on cytokeratin 19 immunopositivity for micrometastasis detection.","authors":"Bin Zheng, Guanglei Huang, Taidui Zeng, Shuliang Zhang, Chun Chen","doi":"10.1093/dote/doae106","DOIUrl":"https://doi.org/10.1093/dote/doae106","url":null,"abstract":"<p><p>No consensus has been achieved for the optimal extent of left recurrent laryngeal nerve para-lymph node dissection (LRLN-LND) for esophageal squamous cell carcinoma (ESCC). Surgeons follow different extents according to their experience, technical proficiency, and habits. Immunohistochemical (IHC) analysis is a feasible method to detect micrometastasis (MM) of lymph nodes in ESCC. We hereby explored the optimal extent of LRLN-LND by detecting the routine pathological and MM-positive rates of lymph nodes in different regions. We retrospectively reviewed patients who underwent R0 resection and LRLN-LND between September 2018 and July 2019. We divided lymph nodes into four groups based on the LRLN and cervicothoracic junction plane: (i) anterior LRLN region above the plane, (ii) posterior LRLN region above the plane, (iii) anterior LRLN region under the plane, and (iv) posterior LRLN region the plane. In total, 263 lymph nodes were collected from 52 patients. We detected MM based on cytokeratin 19 (CK19) immunopositivity in lymph nodes with negative histological detection. We calculated the positive rates of routine pathological and MM detection and analyzed the metastasis status in different regions. Lymph nodes of cervical regions (group 1 and group 2), which are always ignored due to inherent technical difficulties and poor exposure, showed higher positive rates than those in group 4; the rate in group 3 was also higher than that in group 4. Routine histological detection achieved positive rates of 8.9, 6.7, 1.6, and 0.9%, respectively. After the detection of MM by the CK19 IHC method, increased positive rates were achieved. To the best of our knowledge, only a few studies have focused on the optimal extent of LRLN-LND. Because of the high positive rates both in routine pathological detection and by CK19 IHC MM detection in this study, thorough LRLN-LND during esophagectomy for ESCC is necessary, including the cervical region and anterior nerve region adjacent to the trachea.</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":"143469995","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":"Preface for eosinophilic esophagitis special issue.","authors":"Evan S Dellon","doi":"10.1093/dote/doaf010","DOIUrl":"https://doi.org/10.1093/dote/doaf010","url":null,"abstract":"","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":"143469996","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 of transfer from pediatric gastroenterology to adult gastroenterology care in eosinophilic esophagitis.","authors":"Katherine F Webber, James C Slaughter, Dhyanesh A Patel, Girish Hiremath","doi":"10.1093/dote/doaf012","DOIUrl":"10.1093/dote/doaf012","url":null,"abstract":"<p><p>Given the chronic and progressive course of eosinophilic esophagitis (EoE), patients with pediatric-onset EoE will require uninterrupted gastroenterology (GI) care as they reach adulthood. Yet, the effectiveness of transferring and integrating EoE patients from pediatric GI (pGI) to adult GI (aGI) care has not been studied. To address this gap, we assessed loss to follow-up, duration from the last pGI to the first aGI encounters (clinic visit and EGD), and its impact on clinical course and medication non-adherence in EoE patients. We identified 58 EoE patients who initially received pGI care and were transferred to aGI between 2017 and 2023 within our institution's shared electronic medical record environment. Demographic, clinical, endoscopic, and histologic data were analyzed using descriptive statistics, survival analysis, Cox regression models, and paired comparisons. Loss to follow-up was 16%. The median duration from the last pGI clinic visit to the first aGI clinic visit was 299 days, and that for the last pGI EGD to the first aGI EGD was 730 days. A significantly higher odds of heartburn (McNemar P-value = 0.01) and higher medication non-adherence rates (7% vs. 26%) were noted in 49 patients who established care with the aGI. The endoscopic and histologic severity remained unchanged. In EoE patients, transferring from pGI to aGI care is associated with loss of follow-up, deterioration of symptoms, and medication non-adherence. There is a critical need to develop optimized protocols to ensure a seamless transfer of care for EoE patients.</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/PMC11878569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558797","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 cannabis use on presentation and treatment response in eosinophilic esophagitis.","authors":"Stephanie A Borinsky, Alexandra A Weir, Sean S LaFata, Timothy S Gee, Hannah L Thel, Brenderia A Cameron, Angela Z Xue, Akshatha Kiran, Adolfo A Ocampo, Justin McCallen, Christopher J Lee, Walker D Redd, Trevor S Barlowe, Rayan N Kaakati, Cary C Cotton, Swathi Eluri, Craig C Reed, Evan S Dellon","doi":"10.1093/dote/doae080","DOIUrl":"10.1093/dote/doae080","url":null,"abstract":"<p><p>Cannabis use is becoming increasingly common, both for recreational and medical purposes. However, there is a paucity of data regarding cannabis use in the context of eosinophilic esophagitis (EoE). We aimed to determine the impact of cannabis use on presentation and treatment response in EoE. To this end, we conducted a retrospective cohort study at a large academic medical center of newly diagnosed EoE patients age ≥ 12 years. Self-reported cannabis use status, baseline characteristics, and treatment response to topical corticosteroids and dietary therapy data were extracted. Bivariate and multivariable analyses were used to compare cannabis users and non-users at time of EoE diagnosis and to assess treatment response. Of 983 EoE patients, 80 reported using cannabis, with the majority reporting daily use and administration by inhalation. Baseline symptoms and peak eosinophil count were similar between cannabis users and non-users; cannabis users were less likely to have baseline endoscopic findings of exudates, edema, and stricture, and lower total Endoscopic Reference Score. On multivariable analysis, younger age, male sex, non-White race, and psychiatric diagnosis were independently associated with history of cannabis use at EoE presentation and stricture was independently associated with cannabis non-use. Post-treatment symptom and histologic responses were similar between cannabis users and non-users though there was a higher odds of post-treatment endoscopic inflammatory features with cannabis use. In conclusion, despite presenting with milder initial endoscopic findings, cannabis users exhibited greater inflammatory findings after treatment, highlighting a potential negative influence of cannabis use on EoE management.</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":"142373575","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}