Diseases of the Esophagus最新文献

{"title":"Prolonged wireless pH monitoring increases diagnostic yield in patients with reflux symptoms and borderline 24-hour impedance pH.","authors":"Harumi Hashimoto, María M Piskorz, Juan I Olmos, Julieta Arguero, Andres Wonaga, Mauricio Guzman, Esteban González Ballerga, Jorge A Olmos","doi":"10.1093/dote/doaf030","DOIUrl":"https://doi.org/10.1093/dote/doaf030","url":null,"abstract":"<p><p>The Lyon Consensus defines pathological gastroesophageal reflux disease (GERD) as an acid exposure time (AET) greater than 6%, while AET less than 4% rules it out. AET between 4% and 6% is borderline. Prolonged wireless capsule pH monitoring may enhance GERD diagnosis, though it is not widely used in Latin America. This study aimed to categorize patients with borderline AET as GERD or non-GERD using prolonged wireless capsule pH monitoring, assess treatment response, and compare tolerance and interference with 24-hour impedance testing. Thirty-three patients with persistent reflux symptoms and borderline AET (4%-6%) from a 24-hour impedance study were included. Exclusions were prior esophageal surgery, major motility disorders, or unreliable impedance tests. A 96-hour off-proton pump inhibitor (PPI) wireless capsule pH monitoring was performed. Patients were categorized as GERD (AET >6% for 2+ days) or non-GERD (AET <4% for 4 days). Treatment was based on these categories, and GerdQ scores were assessed at baseline and 8 weeks. Three patients were excluded due to incomplete data. Of the 30 patients, 16 (53%) were classified as GERD, 6 (20%) as non-GERD, and 8 (27%) remained borderline. Wireless capsule monitoring provided a diagnosis in 73% of borderline cases. GERD patients responded well to PPI optimization, while non-GERD patients benefited from neuromodulation. Tolerance and daily activity interference were better with wireless capsule monitoring. Prolonged wireless capsule pH monitoring effectively categorized over 70% of borderline AET patients, leading to improved treatment outcomes with good patient tolerance.</p><p><strong>Key points: </strong></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":"144009802","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: surgical treatment of esophago-tracheobronchial fistulas after esophagectomy.","authors":"Qingzhen Wu, Bo Ning, Enqiang Linghu","doi":"10.1093/dote/doaf002","DOIUrl":"https://doi.org/10.1093/dote/doaf002","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":"143588192","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":"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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187587/pdf/","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":"OA","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":"Evaluating the impact of sling fiber preservation during POEM.","authors":"Yusuke Fujiyoshi, Mary Raina Angeli Fujiyoshi, Christopher W Teshima","doi":"10.1093/dote/doaf023","DOIUrl":"https://doi.org/10.1093/dote/doaf023","url":null,"abstract":"","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":"144046122","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}