Diseases of the Esophagus最新文献

{"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997431/pdf/","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":"OA","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":"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":"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":"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":"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":"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}

{"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":"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}