Annals of esophagus最新文献

{"title":"Esophageal cancer in young patients: does age affect treatment course and outcomes?","authors":"Ethan Y. Song, S. Naffouje, Sabrina Saeed, A. Glaser, Miles E. Cameron, J. Fontaine, L. Peña, M. Friedman, R. Mehta, Sarah Hoffe, J. Frakes, J. Pimiento","doi":"10.21037/AOE-20-92","DOIUrl":"https://doi.org/10.21037/AOE-20-92","url":null,"abstract":"Background: Young patients with esophageal cancer (EC) are believed to have more aggressive disease, thus thought to have worse survival. Herein, we aim to study the impact of younger age on the short- and long-term outcomes of esophagectomy for EC. Methods: Patients who underwent esophagectomy for EC at our institution between 1994–2019 were included. Age 50 was defined as the cutoff for “young” vs . “old”. Patients from each age group were propensity-score matched 1:1 to compare postoperative and survival outcomes. Results: Our database reported 1,031 patients, 112 of whom were in the ‘young’ group. For the unmatched analysis, young patients were more likely to have squamous cell carcinoma, higher rates of locally advanced disease, and subsequently higher rates of neoadjuvant chemotherapy (79.5% vs . 68.3%; P=0.047). After matching for pre-treatment clinical factors, young patients were less likely to have pulmonary or cardiac complications after surgery, and three times more likely to receive AC despite matching for stage and response to treatment (26.7% vs . 7.9%; P=0.002). Then, we matched patients including receipt of AC to study survival. In the second match, median recurrence-free survival (RFS) for young patients was 49.0±26.0 vs . old 27.0±5.4 months (P=0.215). Median overall survival (OS) for young was 73.0±28.9 vs . old 31.0±6.3 months (P=0.073). Conclusions: Young EC patients tend to present with more advanced disease. However, when matched for stage and response to therapies, young patients were three-times more likely to be offered AC. After adjusting for receipt of adjuvant therapy no difference was detected in RFS.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47195903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of artificial intelligence for the detection and staging of esophageal cancer","authors":"Y. Tokai, T. Yoshio, J. Fujisaki","doi":"10.21037/aoe-2020-33","DOIUrl":"https://doi.org/10.21037/aoe-2020-33","url":null,"abstract":": Computer-assisted diagnosis (CAD) using deep learning, based on convolutional neural networks (CNNs), is rapidly developing in modern society and clinical practice. In the medical field of endoscopy, a CAD system can be used in the detection and staging of superficial esophageal cancer. In the detection of superficial esophageal squamous cell carcinoma (ESCC), several studies were reported as using still images of conventional white-light endoscopy and narrow-band imaging (NBI). The sensitivity of CAD systems is over 90%, and in some reports, higher than that of expert endoscopists. In addition, there is a report using video for a validation set that showed good performance. In diagnosing invasion depth, there are reports using conventional white-light imaging, NBI, and magnifying endoscopy with NBI using still images; there are also reports of intrapapillary capillary loop pattern identification using still images. Using white-light endoscopy and NBI, CAD systems showed sensitivity of 84.1–95.4%, specificity of 73.3–79.2%, and accuracy of 80.9–92.9% for differentiating SM1 cancers from SM2 or SM3 cancers in pathology. Additional systems could accurately classify intrapapillary capillary loop patterns as normal or abnormal, with comparable performance to experienced endoscopists. As for esophageal adenocarcinoma (EAC) that arises in Barrett’s esophagus (BE), there are detection reports that show favorable performance. Furthermore, the CAD system from one report identified the location suitable for biopsy; this is helpful for endoscopists because of the difficulty in determining the location of early EAC in BE. Although these studies are still only at research level, excellent performance has been achieved for detecting and staging of superficial esophageal carcinoma by CAD systems. In the near future, CAD systems will support us in detecting and staging esophageal cancers in daily clinical practice, leading to a better prognosis. 9","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68296765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted hand-sewn intrathoracic anastomosis after esophagectomy","authors":"E. M. D. Groot, Feike Kingma, L. Goense, S. Horst, J. W. Berg, R. Hillegersberg, J. Ruurda","doi":"10.21037/AOE-20-98","DOIUrl":"https://doi.org/10.21037/AOE-20-98","url":null,"abstract":"Background: In two-stage minimally invasive esophagectomy (MIE), most surgeons use a stapling device to avoid the challenges of thoracoscopic suturing in the upper mediastinum. However, in robot-assisted minimally invasive esophagectomy (RAMIE), the surgeon benefits from increased dexterity that facilitates the construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of a refined technique for the robot-assisted hand-sewn intrathoracic anastomosis in RAMIE, which was introduced in 2016 in our center. Methods: Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis between 1 November 2019 and 1 November 2020 were included in the current retrospective study. During this time frame, the technique was uniform and no more refinements were made. Data were extracted from a prospectively maintained database. Main elements of the anastomotic technique included supportive stay-stitches to keep esophageal mucosa to the muscular wall, manual barbed suturing of the posterior and anterior wall, placement of tension releasing stitches and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage and secondary outcomes included the duration of anastomosis construction. Results: During the inclusion period, 22 patients were included in the study. Anastomotic leakage occurred in 3 patients (14%), which involved a grade I leak in 2 patients (9%) and grade 3 leakage in 1 patient (5%). The total duration of anastomosis construction was 37 minutes (range, 25–48 minutes). Conclusions: This study shows that a robot-assisted hand-sewn intrathoracic anastomosis can yield good outcomes in RAMIE.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46890774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the challenge in esophageal anastomosis","authors":"A. Nieponice","doi":"10.21037/aoe-21-72","DOIUrl":"https://doi.org/10.21037/aoe-21-72","url":null,"abstract":"","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45842800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of therapy of Barrett’s esophagus and related cancer: a narrative review","authors":"N. Pilonis, M. Pietro","doi":"10.21037/AOE-20-93","DOIUrl":"https://doi.org/10.21037/AOE-20-93","url":null,"abstract":": Barrett’s esophagus (BE) is an intestinal-type metaplastic condition of the esophagus, which occurs in response to severe inflammation generally as result of chronic gastro-esophageal reflux. Over the last 5 decades, since the link between BE and esophageal adenocarcinoma (EAC) has been established, endoscopy has played a key role in the management of this condition, as a procedure initially to diagnose and monitor the precancerous disease and more recently also to deliver therapeutic interventions. The treatment algorithm for BE has seen dramatic changes in the last 10 years thanks to the better understanding of the natural history of dysplasia and early EAC and to the advent of effective endoscopic ablation techniques. Nevertheless, the incidence of EAC is increasing worldwide and many questions still remain to be addressed. There is growing need to combine technological advances with early diagnosis and targeted pharmacological treatments in order to refine management strategies. This would ideally entail early intervention on patients with a high probability to progress to cancer and minimally invasive treatment in patients with cancer at low metastatic risk. In this article we will discuss how improved understanding about the molecular make up of the disease and the emerging diagnostic and therapeutic technologies at the horizon can help reshape the endoscopic management of BE in the near future. 15","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42703338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and spontaneous esophageal perforation: a case report","authors":"S. S. Rao, Katy Marino, M. Steliga, J. Muesse","doi":"10.21037/aoe-20-60","DOIUrl":"https://doi.org/10.21037/aoe-20-60","url":null,"abstract":": Pulmonary manifestations of the novel coronavirus, COVID-19, have been discussed heavily in the literature, however, there have been minimal reports regarding extra-pulmonary manifestations of the disease to date. In particular, there has been no literature to date discussing the pathophysiology or incidence of esophageal perforation in the COVID-19 patient. This case report describes a 65-year-old COVID-19 positive male presenting with a case of spontaneous esophageal perforation. The patient underwent esophagogastroduodenoscopy (EGD) with stent placement followed by thoracoscopic evacuation of gastric contents from the pleural spaces and mediastinal drainage. His clinical course was unique in that his esophageal perforation management was complicated by logistical and technical challenges due to COVID-19 infection. Several precautions were required before, during and after each test or intervention performed on the patient. This created a challenging set of circumstances which had not been dealt with in the past. Nevertheless, after a two-week hospital stay, the patient was discharged in stable condition with plans for outpatient follow-up and removal of stent. This case report provides an unusual presentation of esophageal perforation in a patient with concurrent COVID-19 infection while highlighting the special techniques required to diagnose and treat the patient. 5","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47856126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of esophageal perforations and benign diseases","authors":"D. Nachira, V. Porziella","doi":"10.21037/AOE-2020-MEP-02","DOIUrl":"https://doi.org/10.21037/AOE-2020-MEP-02","url":null,"abstract":"","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49522085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern evaluation of esophageal function in the gastrointestinal motility laboratory: a narrative review","authors":"M. Malamood, D. Shahsavari, H. Parkman","doi":"10.21037/aoe-21-36","DOIUrl":"https://doi.org/10.21037/aoe-21-36","url":null,"abstract":"Objective: To review the current state of functional esophageal evaluation in the gastrointestinal (GI) motility laboratory, highlighting updates in established modalities along with new technologies. Background: The GI motility laboratory has been transformed the decade, modernizing its approaches for the evaluation of esophageal motility disorders and gastroesophageal reflux disease (GERD). Conclusions: The esophageal motility evaluation often starts with high-resolution esophageal manometry, now with enhanced protocols using provocative maneuvers to increase detection and understanding of esophageal motility disorders. Esophageal manometry now involves recording esophageal motility both in the supine and upright positions as well as in response to multiple rapid swallows and rapid drinking challenge. Endoscopic functional luminal imaging probe (EndoFLIP) using impedance planimetry technology can assess the compliance of the lower esophageal sphincter (LES), as well as can be utilized for assessment of esophageal motility during endoscopy. Ambulatory esophageal pH monitoring studies remain the standard for the diagnosis of GERD. Multichannel intraluminal impedance-pH (MII-pH) has the advantage of measuring impedance to identify non-acidic reflux episodes—a particularly important feature in patients not responding to proton pump inhibitors (PPIs), those with atypical GERD symptoms, and in patients who cannot stop their PPIs for their evaluation. Novel metrics include mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index which help differentiate GERD, non-erosive reflux disease (NERD), and reflux hypersensitivity from functional heartburn and normal subjects. They also can help predict outcome and response to medical and procedural therapies. Wireless pH capsule monitoring involves endoscopic attachment of a radiotelemetry capsule in the distal esophagus providing multi-day recording of esophageal pH. It is more tolerable than MII-pH allowing patients to resume their daily activities that might precipitate reflux. The GI motility laboratory has modernized approaches for the evaluation of esophageal function. for impedance For normal subjects PPI the upper of AET is 2.5% and normal subjects taking PPI BID, the upper limit of esophageal acid exposure to 1.3%.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49583282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic role of positive circumferential resection margins after curative intent surgery for locally advanced esophageal adenocarcinoma","authors":"Élise Di Lena, J. Molina, A. Siblini, C. Huynh, C. Mueller, J. Spicer, D. Mulder, Lawrence Lee, L. Ferri, J. Cools-Lartigue","doi":"10.21037/AOE-20-94","DOIUrl":"https://doi.org/10.21037/AOE-20-94","url":null,"abstract":"The use of the circumferential resection margin (CRM) in esophageal carcinoma stems from rectal carcinoma literature which was extrapolated to esophageal cancers (1). It has since become a standard of pathological reporting and a prognostic marker over the last 20 years. However, the usefulness of CRM as a prognostic marker in locally advanced esophageal adenocarcinoma (ADC) has been a Original Article","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68296878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic palliation of esophageal cancer: a narrative review apart from stenting","authors":"Danjing Zhao, Kevin Shahbahrami, H. Fernando","doi":"10.21037/aoe-21-51","DOIUrl":"https://doi.org/10.21037/aoe-21-51","url":null,"abstract":"Esophageal cancer remains the eighth-most common cancer and the sixth-most common cause of death worldwide. Prevalence within the United States alone is estimated to be 19,260 cases and expected to result in 15,530 deaths during 2021 (1). While surgery and neoadjuvant chemotherapy and radiation remain an important cornerstone in the treatment algorithm for many patients with early stage and locoregional disease, most patients are diagnosed at advanced stages, and non-surgical palliative treatment modalities become an important part of the physicians’ armamentarium. Dysphagia and bleeding resulting in hematemesis and anemia can significantly impact quality of life in these patients. Endoluminal treatment options have become increasingly important, as these modalities allow dysphagia, risk of aspiration, and resulting malnutrition to be resolved to varying degrees. In this paper, we will focus on endoluminal ablative options such as photodynamic therapy (PDT) and cryotherapy. Esophageal stenting will be discussed elsewhere Review Article","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68296992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}