Esophageal Surgery Research Papers - Academia.edu (original) (raw)

2025, Indian Journal of Veterinary Surgery

2025, Pleven Blog&Journal

Achalasia is a rare primary motor disorder of the oesophagus, characterized by the failure of the lower esophageal sphincter (LES) to relax and by the absence of peristalsis, resulting in symptoms such as dysphagia, regurgitation, and weight loss. During routine dissection of the posterior mediastinum at the Anatomy Department of the Medical University of Pleven, an anatomical anomaly involving the esophagus was observed, prompting further investigation into esophageal motor disorders. This article integrates clinical, diagnostic, and therapeutic perspectives on achalasia with particular attention to anatomical context. A classification of achalasia into types I, II, and III is discussed, along with diagnostic tools such as barium studies, high-resolution manometry, and endoscopy. Treatment options-ranging from pneumatic dilation and Heller myotomy to botulinum toxin injections-are reviewed, with emphasis on their mechanisms and limitations. Psychological effects, including anxiety, depression, and social withdrawal, are also addressed, highlighting the need for a multidisciplinary approach. This case underscores the importance of anatomical variations in understanding the pathophysiology of achalasia. Although there is no definitive cure, tailored treatment strategies and long-term follow-up can significantly improve patient outcomes and quality of life.

2025, Annals of the New York Academy of Sciences

The following on achalasia and disorders of the esophageal body includes commentaries on controversies regarding whether patients with complete lower esophageal sphincter (LES) relaxation can be considered to exhibit early achalasia; the roles of different mucle components of the LES in achalasia; sensory neural pathways impaired in achalasia; indications for peroral endoscopic myotomy and advantages of the technique over laparoscopic and thorascopic myotomy; factors contributing to the success of surgical therapy for achalasia; modifications to the classification of esophageal body primary motility disorders in the advent of high‐resolution manometry (HRM); analysis of the LES in differentiating between achalasia and diffuse esophageal spasm (DES); and appropriate treatment for DES, nutcracker esophagus (NE), and hypertensive LES (HTLES).

2025

Colorectal cancer (CRC) is the most commonly diagnosed and the second most common cause of cancer-related death in Hong Kong. Most patients die from tumour relapse or metastatic disease. Radical resection is the main treatment method for... more

2025, Case Report - Claude-Bernard-Horner Syndrome associated with Esophageal Carcinoma (Atena Editora)

Introduction: Esophageal squamous cell carcinoma is a malignant neoplasm that originates in the esophageal epithelium and is one of the most aggressive and lethal forms of digestive cancer. It is often diagnosed late due to the absence of specific symptoms in the early stages. For example, dysphagia, the main symptom, only appears when the carcinoma has compromised two thirds of the organ's lumen. Its progression can lead to various complications, including the development of a megaesophagus and Claude-Bernard-Horner Syndrome, as occurred in the patient in this case report. The relationship between these pathologies demonstrates the complexity of the case and the need for a multidisciplinary approach in the treatment of such patients. Case Report: A 39-year-old male patient was evaluated for suspected megaesophagus. Chest computed tomography showed a marked esophageal ectasia extending through the right hemithorax with a large volume of impacted debris and parietal calcifications, as well as an expansive right paravertebral formation at the apex of the right hemithorax at the D1/D2 level, causing partial destruction of the vertebral body and homolateral posterior arch elements. The anatomopathological examination confirmed the diagnosis of moderately differentiated squamous cell carcinoma of the esophagus.

2024, IJLR

A three-year-old Holstein Friesian crossbred heifer was referred with the history of inappetence, drooling and improper rumination since a week. A systematic physical examination followed by a sonogram and survey and contrast (Barium) oesophagram was done for a confirmative diagnosis. The results of clinical examination and radiography helped to confirm the diagnosis of oesophageal diverticulum. Surgical management of the acquired condition was successfully performed and shortly post -operative, the patient recouped completely.

2024

Objective: Neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced, high-risk breast cancer. Pathological complete response (pCR) improves survival. Peripheral blood-derived indices re ecting systemic in ammation and nutritional status have long been used as predictive and prognostic markers in solid malignancies. This retrospective study investigates whether eight commonly used indices in patients receiving NACT effect on pCR and survival. Methods: This study includes 624 patients with locally advanced breast cancer who received NACT. The biomarker indices were calculated from peripheral blood samples taken two weeks before starting chemotherapy. Optimal cutoff values of the indices were determined using ROC Curve analysis. Results: During a median follow-up period of 42 months, recurrence was detected in 146 patients, and 75 patients died. pCR was observed in 166 patients (26.6%). In univariate analysis, NLR, PLR, SII, PNI, HALP, and HRR were statistically signi cantly associated (p=0.00; p=0.03; p=0.03; p=0.02; p=0.00; p=0.02 respectively), but in multivariate analysis, only NLR was signi cantly predictive for pCR(p=0.04). Inn multivariate analysis, the HGB/RDW score signi cantly predicted DFS(p=0.04). The PNI score was identi ed as a marker predicting survival for both OS and PFS(p=0.01, p=0.01, respectively). Conclusion: In conclusion, peripheral blood-derived indices have prognostic and predictive values on pCR and survival. However, further studies are needed to validate our ndings.

2024, World Journal of Gastrointestinal Surgery

BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition. The optimal management strategy is still unclear. AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks. METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023. Clinical outcomes were analyzed, and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus, when feasible. RESULTS Among the whole series of 60 patients, an urgent surgery was required in 8 cases due to a septic state. Fifty-six patients were managed by endoscopic or hybrid treatments, obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus. The mean time to resolution was 54.95 ± 52.64 days, with a median of 35.5 days. No severe complications were recorded. Ten patients out of 56 (17.9%) developed pneumonia that was treated by specific antibiotic therapy, and in 6 cases (10.7%) an atrial fibrillation was recorded. Seven patients (12.5%) developed a stricture within 12 months, requiring one or two endoscopic pneumatic dilations to solve the problem. Mortality was 1.7%. CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

2024, NEOADJUVANT CONCURRENT CHEMORADIOTHERAPY IN PATIENTS OF ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION CANCER (SINGLE INSTITUTE STUDY)

Background: Esophageal cancer and cancers of the gastroesophageal junction pose significant clinical challenges due to their aggressive nature and often late-stage diagnosis. Neoadjuvant concurrent chemoradiotherapy (CRT) has emerged as a pivotal therapeutic strategy in the management of locally advanced disease. By combining chemotherapy with radiation therapy before surgical intervention, neoadjuvant CRT aims to reduce tumor burden, increase resectability rates, addresses micro metastasis and improve overall survival outcomes. Objectives: To evaluate pathological response after administering neoadjuvant chemoradiotherapy in patients diagnosed with esophageal cancer and cancers located at the gastroesophageal junction (Squamous cell carcinoma and Adenocarcinoma). Materials and Methods: In this prospective interventional study, we enrolled a total of 36 patients, with a diagnosis of esophageal carcinoma or carcinoma of the gastroesophageal junction aged 18-70 years. The study duration was 6 month from

2024, Hiroshima journal of medical sciences

The purpose of this study was to assess the point at which the postoperative infection has occurred in order to decide upon the proper duration of prophylactic antibiotic use. Another goal of this study was to determine whether prediction for the development of postoperative infections in major surgery such as esophagectomy should be the same as that in routine gastroenterological surgery. Twenty-five patients who underwent transthoracic esophagectomy and 127 patients who underwent gastrectomy were studied. On the third day after gastric surgery, the body temperature of patients who developed an infection was higher than that of the patients who did not develop an infection. The relative changes in peripheral white blood count (WBC), and C-reactive protein (CRP) concentration on the third and fourth days were more predictive of the development of infection than the absolute values. Almost all patients with systemic inflammatory response syndrome (SIRS) on the third day after gastric...

2024, Journal of Clinical Gastroenterology

The aim of the study is verification of efficacy of bilimetry associated to pHmetry to characterize the refluxate in Barrett's esophagus patients (BE). Method: Fourteen volunteers adhered to a standard protocol and 15 BE patients were fasted for 6 h before any exam and the patients ceased acid suppression medications 72 h earlier. Manometric study of the esophagus was performed to localize the LES. Then the Bilitec 2000 fiberoptic probe (Synectics, Medtronic) and an antimony pH probe attached to a Digitrapper Mark III pH recorder (Synectics, Medtronic), together, were inserted through the nostril and positioned 5 cm above LES. An uncolored diet was recommended and after around 24 h, both Bilitec and pH data were downloaded simultaneously to a personal computer for analysis, using the Synectics software. Absorbance threshold was set at 0.14 absorbance units and acceptable esophageal pH at 4, to verify rates of altered bilimetry (fraction of time of absorbance > 0.14 over 0.6) and pHmetry (DeMeester score > 14.72) in each group. Results: Thirteen volunteers presented normal pHmetry and one, altered pHmetry; bilimetry was normal in 13 and altered in one; both exams were normal in 85.71% of them. Ten BE patients had normal pHmetry and 5, altered pHmetry; bilimetry was normal in four and altered in 11; both exams were normal in only three patients (20%). Conclusions: Mixed reflux is frequent in BE patients, justifying combined use of 24-h pHmetry and bilimetry to avoid false negative results. P51 KI-67 antigen overexpression is associated with Barrett's carcinogenesis

2024, Biomedical Journal of Scientific and Technical Research

Assisted ventilation in preterm infants treated for respiratory distress syndrome (RDS) may cause typically neonatal pneumomediastinum. [1] It is often anterior or anterolateral to the heart and is caused by the escape of air from the broken alveoli through the perivascular sheaths which, moving towards the hilum, finally reaches the anterior mediastinum [2]. The cause is the development of a pressure difference between the alveoli and the perivascular and peribronchial spaces with alveolar break and diffusion of air to the hilus and into the mediastinum that generate airway stretching with lung damage (volutrauma) [3,4]. The aim of this paper is to analyze these unusual patterns through an approach by multidetector CT (MDCT). We report three cases of loculated/ pseudo cystic para cardiac collections anterior and posterior to the hearth mimicking congenital and non-congenital conditions. Methods Three newborns with respiratory distress and atypical chest X ray signs have been submitted to chest CT. CT studies were performed on one of the following scanners: A secondgeneration dual source CT system (Siemens Somatom Definition Flash, Siemens Erlangen, Germany), with two x-ray tubes and two detectors settled at an angular offset of 95°. A Somaton Sensation 64 (Siemens Medical Solutions, Erlangen, Germany). In both the systems we used a tube current modulation (CARE Dose) with kVp: 70-80 and ref. mAs: 70. Images were reconstructed with a slice thickness of 1 mm. Kernel/Algorithm: B30, B60. With the dual source, Sinogram-Affirmed Iterative Reconstruction (SAFIRE) filter, strength of 1, was employed. None of the children required sedation for CT examinations. We did not inject contrast media because it was considered superfluous. The cases reported for the differential diagnosis studied by CT were performed with the same systems. Cross sectional imaging by MRI was obtained by a 1.5 T MRI scanner

2024, The Journal of Thoracic and Cardiovascular Surgery

Effects of localized chemical carcinogenesis and immunosuppression upon bronchial preneoplasia in the dog Early detection of lung cancer is becoming increasingly more common in clinical practice, but serial studies in patients are rarely possible. To permit serial observations during the preneoplastic stages of carcinogenesis. we employed bronchoscopy to expose 54 dogs recurrently to carcinogens at the orifice of the right accessory (intermediate) lobe bronchus. Benzo(a)pyrene (BP) and N-methyl-N-nitrosourea (NMU), either alone or sequentially, were injected into the bronchial submucosa or were topically applied to the mucosa in three groups of mongrels and two groups of beagles. Long-term immunosuppression with azathioprine and methylprednisolone was used in one group of beagles. Weekly injections of 45 mg. of NMU were found to be excessively toxic. However, weekly submucosal injections of up to 45 mg. of BP and topical application of 5 mg. of NMU were well tolerated. The gross bronchoscopic and histologic changes induced by these carcinogens used singly or in sequence were essentially the same. Marked mucosal irregularity and stenosis were routinely noted by the third month. Serial monthly biopsies of the sites of carcinogen exposure regularly revealed columnar hyperplasia within the first month. Squamous metaplasia occurred as early as 4 weeks after the first chemical exposure, and it became a persistent and progressive feature by the third month. Atypical structure with increased mitotic activity was recurrently seen, and 76 percent of all dogs have squamous metaplasia with atypia. Chronic immunosuppression did not alter the pattern of gross and histologic changes. Recurrent trauma alone did not cause squamous metaplasia or any other preneoplastic change. We conclude that the sequential use of BP-NMU has proved safest and most effective of the methods used in producing bronchial preneoplasia in the dog. The use of adjuvant immunosuppression has not proved worth while. A predictable, reproducible means of producing localized endobronchial preneoplasia in the dog has been developed.

2024, Frontiers in Nutrition

ObjectiveThe Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score and the Geriatric Nutrition Risk Index (GNRI) are used as prognostic factors in different types of cancers. In this study we analyzed the prognostic value of the HALP Score and the GNRI calculated prior to first-line treatment in patients diagnosed with de novo metastatic non-small cell lung cancer (mNSCLC).Materials and methodsDe novo mNSCLC patients were retrospectively evaluated from January 2016 to December 2019. Patients with Driver’s mutation, severe comorbidities, active infection, or insufficient organ function, and those receiving anti-inflammatory treatment were excluded from the study. Optimal cut-off points for the HALP score and the GNRI were calculated with the receiver operating characteristic (ROC) curve analysis. Predictive factors for overall survival (OS) were assessed with univariate and multivariate Cox proportional hazard analyses, and OS was studied with the Kaplan–Meier analysis.ResultsTh...

2024, Bratislavské lekárske listy

INTRODUCTION: Breast-cancer is a common-cause of death in women.(1) We investigated the effects of before/after-NACT on hemoglobin-albumin-lymphocyte-platelet (HALP) scores and of changes therein on clinical/pathological-responses. MATERIALS AND METHODS: One-hundred-twenty-seven breast-cancer-patients receiving-NACT between December 2009-January 2019 were investigated retrospectively. RESULTS: The mean-age was 50.3±12.3 (min 27-max 79), and 125 patients (98.4 %) were women. Fiftyfour (42.5 %) were premenopausal and 71 (55.9 %) postmenopausal. Invasive-ductal-carcinoma was present in 111 patients (92.5 %). Eighty patients (70.2 %) were ≤ T2 and 34 (29.8 %) > T2. Lymph-node-status was positive in 99 patients (83.2 %) and negative in 20 (16.8 %). Ki-67 was ≤ 10 % in 22 (28.9 %), 11-20 % in 23 (30.3 %), and > 20 % in 31 (40.8 %). Complete clinical response was observed in 27 (21.3 %), partialresponse in 76 (59.8 %), stable-disease in 21 (16.5 %), and progressive-disease in 3 patients (2.4 %). The objective-response-rate (ORR) was 103 (81.1 %). Pathological-complete-response (pCR) was observed in 24 patients (18.9 %). ORR was higher in Ki-67 > 20 % compared to ≤ 10 % and 10-20 % (90.3 % vs 59.0 % / 78.3 %, respectively, p: 0.027), but no difference occurred in pCR. Neutrophil-lymphocyte-ratio (NLR), platelet-lymphocyte-ratio (PLR), prognostic-nutritional-index (PNI), and HALP were measured before/after NACT. Associations with ORR and pCR were investigated via changes in these with NACT (excepting-PNI), but no-signifi cant results emerged. CONCLUSIONS: Higher ORR occurred post-NACT in patients with Ki-67 >20 %, while NLR, PLR, PNI, and HALP before/after-NACT and post-NACT-changes (excepting-PNI) had no-effect on ORR/pCR (Tab. 5, Ref. 21).

2024, The International Journal of Medical Robotics and Computer Assisted Surgery

Objective Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is relatively rare, with an incidence of approximately 5%. Sparing of the artery may be required to avoid complications of liver ischemia. Robotic assistance during esophagectomy may provide a technically superior method of artery preservation with minimally invasive approaches. Methods This is a retrospective case series of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE) identified to have a significant RLHA at time of surgery. Results Five patients with a significant RLHA were identified from a series of over 100 RAMIE operations. Preservation of RLHA was accomplished in all cases without need for conversion, no intra-operative complications, and no post-operative liver dysfunction. The stomach was suitable and used for conduit reconstruction in all patients. Conclusions Sparing of the RLHA during RAMIE is feasible and effective. The robotic assisted approach may obviate the need for open conversion during these complex minimally invasive operations.

2024, Diseases of the Esophagus

Background Routine timed barium esophagram (TBE), before and after Heller myotomy and Dor funduplication for achalasia, could offer the unique opportunity to objectively measure the outcome of the surgical procedure. In an initial single center experience we aimed at comparing pre-operative and post-operative TBE to objectively measure esophageal emptying and dilation, and to look for possible factors related to surgery results. Methods From 2016 to 2017, 11 patients underwent Heller myotomy and Dor funduplication for achalasia at a single center; all had a pre-operative and post-operative TBE after one month of surgery. TBE measured height and width of barium column at 1 and 5 minutes. All patients were staged according to radiological achalasia staging system: 1 patient was stage 1 (pre-operative esophageal width between 2 and 3 cm), 4 stage 2 (4–6 cm) and 6 stage 3 (> 6 cm). TBE height and width at 1 and 5 minutes were compared between pre-operative and post-operative TBE by t...

2024, Bratislavské lekárske listy

2024, Journal of Clinical Gastroenterology

2024, Case Reports

This report describes a rare case of glycogenic acanthosis (GA) located on the tongue of a 72-year-old man. The patient presented with a white plaque that had been on the right side of the tongue for 5 years. Histologically, the lesion was characterised by thickened squamous epithelium with abundant intracellular glycogen deposits. No epithelial dysplasia was noted. This is the first report of GA involving the tongue. This benign condition should be added to the large number of lesions responsible for leukoplakia in this anatomical location.

2024, Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology

2024, PubMed

Aim: The prognostic nutritional index (PNI) is a valuable parameter that indicates the immunonutritional status of patients with malignant tumors. Material and methods: Patients operated for colorectal cancer between January 2013 and December 2019 were analyzed retrospectively. The relationship between PNI and morbidity was investigated in the 314 patients included in the study. Based on previous studies, the PNI cutoff value was set at 45, and the patients were duly divided into two groups: PNI <45 and PNI ≥45. The demographic and clinicopathological characteristics, as well as postoperative complications in the two groups, were compared. Results: There was no statistical difference in gender, localization, T stage, N stage, perineural invasion, lymphovascular invasion, stage, Ca19-9 values, and body mass index(BMI) between the two groups. In contrast, there was a statistically significant difference in age, complications, and CEA values. (p=0.008, p<0.001, p=0.043, respectively). The median age was lower in patients with high PNI scores than in the low PNI group (61 vs. 64 years). When the patients were examined for complications, 36 (37.1%) patients were observed in the high PNI group, compared to 155 (71.4%) in the low PNI group. In terms of overall survival, the mean life expectancy was 68.112 2.646 months for patients with low PNI group, compared to 84.626 2.701 months in the high-PNI group, and the difference was statistically significant (p=0.001). Conclusion: This study's findings suggest that the preoperative prognostic nutritional index may indicate postoperative complications and prognosis. The most significant benefit of this marker is that it can be improved preoperatively and practically. Key words: Nutritional Status, Morbidity, Colorectal Neoplasms.

2024, Diseases of The Esophagus

2024, Diseases of the Esophagus

The treatment of ingestion of caustic agents is controversial in the literature. Surgical therapy has been shown to be the best way to proceed, but the surgical methodology has been varied according to the patient's involvement. This study aims to expose the experience of a single institution in relation to the methodology used for the surgical treatment of esophageal stenosis by ingestion of a caustic substance. A retrospective study was carried out in which data were collected from 27 patients who underwent a surgical procedure for the treatment of esophageal stenosis due to alkali ingestion at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 2010 and 2019 and their subsequent comparison between the conduits used in the surgical intervention. Fisher's test was performed to compare the groups regarding cervical leakage and post-surgical symptoms with a significance level of 5%. Of the 27 surgical procedures for esophageal stenosis due ...

2024, Acta gastro-enterologica Belgica

2024, Revista Tecnura

Por medio de este artículo se explorarán las técnicas más sobresalientes utilizadas actualmente para la detección del habla sub-vocal tanto en personas con parálisis cerebralcomo para aplicaciones comerciales (por ejemplo, permitir la comunicación en lugares ruidosos). Las metodologías expuestas se ocupan de adquirir y procesar las señales del habla desde diferentes niveles de su generación, de esta manera se presentan métodos que detectan y analizan señales desde que estas son producidas como impulsos neuronales en el cerebro, hasta que llegan al aparato fonador ubicado en la garganta, justo antes de ser pronunciadas. La calidad de la adquisición y procesamiento dependerá de varios factores que serán analizados en las siguientes secciones. La primera parte de este artículo constituye una breve explicación del proceso completo de generación de voz. Posteriormente, se exponen las técnicas de adquisición y análisis de las señales del habla sub-vocal, para finalmente incluir un análisi...

2024, Obesity Surgery

The prevalence of morbid obesity has been increasing worldwide. Therefore, multiple laparoscopic adjustable gastric bandings (LAGBs) have been placed in Belgium in the nineties. The procedure was considered as minimal invasive with low morbidity rates. However, some publication cases suggest a possible association between LAGB and the onset of an esophageal cancer. We present a case of a 49-year-old female who consulted for dysphagia, epigastric pain, and anorexia 17 years after LAGB. An esophageal squamous cell carcinoma was diagnosed in the distal esophagus, close to the lap band. The diagnostic value of the performed contrast swallow study seemed limited. We suggest that a routinely gastroscopic evaluation in the long-term follow-up after LAGB should be strived for in patients presenting with late-onset dysphagia.

2023, Diseases of The Esophagus

patients with esophageal motility disorders (EMD). The first aim was to elucidate the detection ratio for EMD with EGD. The second aim was to clarify useful EGD parameters associated with them. Methods: Participants included 372 patients who underwent EGD before high resolution manometry for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, spastic and non-occlusive contraction. The EGD finding was positive when at least one EGD finding was detected. HRM diagnoses were made based on the Chicago classification (v3.0). Results: Of 372 participants, pseudoachalasia were diagnosed in 6 patients (1.61%), EMD in 250, and normal in 116. The detection ratio for each EMD by EGD is shown in Table 1. There were significant differences in the detection ratio among the three groups (81.1% in major, 50.0% in minor EMD and 15.5% in normal, P < 0.05). On multivariate analysis, resistance when passing through the EGJ (adjusted odds ratio (aOR): 3.99; 95% CI [1.26-12.66]), and non-occlusive contraction (aOR: 10.3; 95% CI [5.26-20.19]) were significantly associated with EMD. Conclusion: The ratio of abnormal EGD findings was different in each EMD. Major EMD can be screened with EGD. Among several endoscopic parameters related with EMD, the non-occlusive contraction is most useful endoscopic parameter.

2023, Diseases of the Esophagus

Background Achalasia is a primary neurodegenerative disease of the esophagus characterized by loss of function of the lower esophageal sphincter (LES) and aperistalsis of the body of the esophagus. Among the diagnostic elements, conventional or high-resolution esophageal manometry is the ‘gold standard’ for diagnosis. In this study, our objective was to investigate the epidemiology and characteristics of patients with Achalasia, seen at the CNCMA, Cuba. Methods A retrospective, descriptive and observational study was performed on patients with Achalasia, diagnosed through conventional esophageal manometry, from January 2006 to December 2015. The database of patients diagnosed with the disease is analyzed at the center's Motility Laboratory. Esophageal manometries were performed by the perfusion method, with Medtronic equipment, 4 register channel catheters, at 5 cm from each other, with Polygram software, from 2005 to 2008 and from then on with catheters Zynetic, Alpine, and Pol...

2023, Carcinogenesis

Oesophageal papillonias were induced in male F344 rats by continuous exposure to A'-nitrosomethylbenzylamine (NMBzA) and Af-nitrosomethyl(2-methylbutyl)amine in the drinking water at concentrations of 10 and 19.5 p.p.m. respectively. After 81-141 days animak received a single i.p. chasing dose of NMBzA (0.1 mmol/kg), [ 14 C-methji]NMBzA or A r-nhroso[ 14 C-methyl]amylamine and were killed 6 h later. Induced papillomas (3-9 per animal) were analysed by autoradiography and by immunohistochemistry using a polyclonal antibody to <9 6-methyldeoxyguanosine. Both techniques revealed the presence of high levels of alkylation products in all papiOomas investigated. Immunohistechemical staining of C^-methyldeoxyguanosine was largely restricted to nuclei of the basal layer and of epithelial cells with incipient keratinization. These findings demonstrate that NMBzA and JV-nitrosomethylamylamine and probably related methylalkylnitrosamines are effectively bioacti vated in premalignant lesions, indicating that during chronic exposure papillomas can acquire additional mutations that are likely to play a major role in tumour progression.

2023, Carcinogenesis

2023, F1000Research

Background: Oral Squamous Cell Carcinoma is a major health burden in Asian countries necessitating the need for active research in terms of diagnosis and management. Various pro-inflammatory markers such as Interleukins, TNF Alpha, Interferon gamma and inflammatory mediators such as Neutrophils, lymphocytes, monocytes and mast cells are known to be involved in the tumor associated inflammatory status. Aim: To explore the role of Interleukin-6, Neutrophil to Lymphocyte ratio and Platelet to lymphocyte ratio in Oral Squamous Cell Carcinoma in both pre and post operative conditions. Materials and Methods: Forty subjects who were Clinically and Histopathologically diagnosed, graded and staged based on TNM staging of OSCC included in the study. Pre and Post operative assessment of serum Interleukin-6, Neutrophil to Lymphocyte Ratio and Platelet Lymphocyte Ratio was carried out. Results: On evaluation significant difference was evident on comparison between the preoperative IL-6 levels and post operative levels. On evaluation of NLR, there was also a significant difference in preoperative NLR based on the staging of the tumor, the mean preoperative NLR higher in stage Iva than in stage III. On evaluation of PLR, the mean preoperative PLR differed significantly between stage III and stage IV a OSCC. However, no evaluative difference was noted in pre and post operative PLR based on the histopathological type of OSCC. But, there was a significant difference noted in the PLR levels between the pre and the post operative status. Conclusion: NLR and PLR are useful markers representing the stage of the tumor as higher values of NLR and PLR are associated with high stages of tumor. Pre and Post operative IL-6 and PLR can also be useful in post operative and post treatment inflammatory status in individuals affected with Oral Squamous Cell Carcinoma. Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

2023, Diseases of The Esophagus

Four research questions, based on the PICO framework, guided the SLR which was conducted up to December 22nd, 2021. The search was performed across different databases including PubMed, MEDLINE (OVID), EMBASE, Cochrane Library, Web of Science, Google Scholar, Emcare and Academic Search Premier. References were independently screened by two reviewers (PMC and AA) who also independently assessed the full text of eligible articles, and extracted data. Due to heterogeneity of retrieved studies, narrative summaries are used to present the data.

2023, Pneumologia (Bucharest, Romania)

English: Background: It is recognised that systemic inflammation plays an important role in the development and progression of lung cancer. Several affordable biomarkers could be used to evaluate systemic inflammation: neutrophil-to-lymphocyte ratio (NLR), plateletto-lymphocyte ratio (PLR) and erythrocyte sedimentation rate (ESR). These biomarkers may be linked with survival in lung cancer. Aim: To assess the relation between systemic inflammation evaluated by NLR, PLR and ESR, tumour nodes metastasis (TNM) staging and negative outcome in lung cancer. Materials and methods: Patients with lung cancer were classified (7th TNM lung cancer staging) into two groups: Group A (resectable stages) and Group B (nonresectable stages). Each group was divided into two subsets: survivors (As, Bs) and deceased (Ad, Bd) patients. Complete blood count (CBC) and ESR were determined. NLR and PLR were calculated. NLR, PLR and ESR values were compared between the two groups and their subsets. Results: 102 consecutive patients completed the protocol.

2023, Indian Journal of Gastroenterology

2023, Annals of Translational Medicine

Background: The use of bibliometrics can help us identify the most impactful articles on a topic or scientific discipline and their influence on clinical practice. We aimed to identify the 100 most cited articles covering esophageal motility disorders and examine their key characteristics. Methods: The Web of Science database was utilized to perform the search, using predefined search terms. The returned dataset was filtered to include full manuscripts written in the English language. After screening, we identified the 100 most cited articles and analyzed them for title, year of publication, names of authors, institution, country of the first author, number of citations and citation rate. Results: The initial search returned 29,521 results. The top 100 articles received a total of 20,688 citations. The most cited paper was by Inoue et al. (665 citations) who first described peroral endoscopic myotomy (POEM) for treating achalasia. The article with the highest citation rate was the third version of the Chicago Classification system, written by Kahrilas and colleagues. Gastroenterology published most papers on the list (n=32) and accrued the highest number of citations (6,675 citations). Peter Kahrilas was the most cited author (3,650 citations) and, along with Joel Richter, authored the highest number of manuscripts (n=14). Most articles were produced in the USA (n=66) between the years 1991 and 2000 (n=32). Conclusions: By analyzing the most influential articles, this work is a reference on the articles that shaped our understanding of esophageal motility disorders, thus serving as a guide for future research.

2023, Medicine

Rationale: We report a unique case of a tripartite esophageal collision tumor consisting of three separate histologic types. Patients concerns: Therapeutic dilemmas on the proper treatment of those rare neoplasms remain unanswered considering both proper surgical therapy and adjuvant therapy. Diagnose: In this paper, we report a unique case of a patient with a tripartite esophageal collision tumor consisting of a small cell carcinoma, an adenocarcinoma of medium differentiation and a signet ring cell carcinoma. Diagnosis is difficult as clinical presentation of the patient was undistinguishable from other, commoner tumor types. Interventions: The patient's diagnostic and therapeutic course along with available data on the collisions tumor's biological behavior and treatment are briefly discussed. Outcomes: Esophagectomy is the best treatment options for these patients. Unique nature of this tumor demands aggresive oncologic treatment. Lessons: Collision tumors are rare neoplasms consisting of distinct cell populations developing in juxtaposition to one another without any areas of intermingling. Various cell types can be found. However, collision neoplasms of the esophagus combining adenomatous and neuroendocrine components are exceedingly rare, with only 5 cases described to date in the literature. Given their rarity, limited information is available on their tumorigenesis, biological behavior and clinical course. In general, these tumors are aggressive neoplasms and significantly affect patient treatment and prognosis. Abbreviations: LOH = loss of heterozygocity, MANEC = mixed adeno-neuroendocrine neoplasm carcinoma, SCC = small cell carcinoma, SqC = squamous cell carcinoma.

2023, Advanced Research in Gastroenterology & Hepatology

Introduction: Upper gastrointestinal tract lesions are the leading cause of morbidity and mortality worldwide. Upper gastrointestinal symptoms include dysphagia, vomiting, anorexia, retrosternal pain, weight loss and mass abdomen and patients may present with visible red and white mucosal lesions, ulcers, polypoidal or ulcerative growth in upper gastrointestinal tract (GIT) Observation: Fifty patients suspected of having upper gastrointestinal malignancies, from the gastroenterology ward/OPD were included in the study. Results: In our study, maximum number of cases were in the age group of 41-60 years with the mean age being 58 years. Male to female ratio was approximately 2:1. Maximum number of patients (42 cases) presented with dysphagia Conclusion: Although endoscopic biopsies are an established gold standard for diagnosing gastrointestinal malignancies but brush cytology can be used as an accurate diagnostic adjunct to biopsy in diagnosis of cancer and an important screening technique for detecting upper gastrointestinal malignancy in high risk population and in cases where difficulty is encountered in obtaining adequate tissue for histopathological examination.

2023, Journal of Clinical Medicine

Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperati...

2023, Cancer Epidemiology, Biomarkers & Prevention

Background: The incidence of esophageal adenocarcinoma was increasing in the Western Europe and United States, but not in East Asian countries. Population based study on the trend of esophageal adenocarcinoma in Hong Kong was not available. Materials and Methods: Population-based data of Hong Kong Cancer Registry from 1984 to 2003 were used. Cases were grouped into four 5-year periods. Average age standardized rate (WSR) of each period was calculated by averaging the WSR of the 5 years in each period, basing on the world standard population, with adjustment made for cases with missing histology. Results: 10,751 new cases of esophageal neoplasm were studied (8,637 males and 2,114 females). Esophageal adenocarcinoma declined among both males and females, with the total number decreased from 224 in 1984 to 1988 to 131 in 1998 to 2003. WSR decreased from 1.10 of 100,000 in 1984 to 1988 to 0.34 of 100,000 in 1998 to 2003. The decline was faster than that for esophageal squamous cell carc...

2023, European Archives of Oto-Rhino-Laryngology

Purpose Although the serum albumin/globulin ratio (AGR) is recognized as a valuable prognostic biomarker in various cancers, its clinical value in oral cavity squamous cell carcinoma (OSCC) is still unclear. We aimed to probe the prognostic value of AGR in patients with OSCC undergoing curative surgery. Methods This retrospective study analyzed 306 patients who were newly diagnosed as having OSCC and receiving curative surgery between 2008 and 2017. The correlation of AGR with survival outcomes was estimated using Cox proportional hazards models and Kaplan-Meier analysis. A nomogram based on AGR was established, and its accuracy was assessed according to the concordance index. Results The log rank test and Kaplan-Meier analysis indicated that patients who had low AGR had significantly shorter disease-free survival (DFS) as well as 5-year overall survival (OS) than those with high AGR. The multivariate Cox analysis revealed that low AGR was an independent predictor of poor OS and DFS (adjusted hazard ratio [aHR] = 2.812; 95% CI 1.729-4.573; p < 0.001, and aHR = 1.743; 95% CI 1.201-2.530; p = 0.003, respectively). The concordance index of the nomogram model based on TNM staging alone was 0.656 and could increase to 0.783 with the inclusion of AGR and other prognostic variables in the calculation. Conclusion Preoperative AGR may represent an accessible, valuable prognostic biomarker in patients with OSCC. The nomogram model incorporating AGR and clinicopathological prognostic variables may improve the accuracy of prognostic predictions in these patients.

2023, OncoTargets and therapy

There is increasing evidence that systemic inflammation influences the prognosis in patients with malignant tumors. The aim of this research was to investigate the prognostic value of neutrophil/lymphocyte ratio (NLR) in patients with primary small-cell carcinoma of the esophagus. This study retrospectively analyzed 129 patients with primary small-cell carcinoma of the esophagus who underwent esophagectomy in The Fourth Hospital of Hebei Medical University between January 2008 and December 2010. NLRs were calculated by using the following formula: peripheral neutrophil count/lymphocyte count (10(9)/L). Correlations of NLR with other clinicopathologic data and prognosis were analyzed. The survival rate was calculated by Kaplan-Meier analysis. The differences between groups were compared by using the log-rank test. Cox regression was used to analyze the factors that may affect the survival of the patients. The survival rate was found to be related to tumor stage, tumor location, nodal...

2023, Journal of Clinical Medicine

2023, Disease Markers

Background. Controlling nutritional status (CONUT) and tumor markers are associated with prognosis in patients with non-small-cell lung cancer (NSCLC). This study is aimed at exploring the potential usefulness of T-CONUT, constructed by combining CONUT and tumor markers, for NSCLC patients undergoing radical surgery. Methods. A total of 483 patients with NSCLC underwent radical surgical resection. The receiver characteristic operating curve (ROC) was used to select the tumor marker with the highest predictive performance, and CONUT was combined with this marker to construct the T-CONUT. The Kaplan–Meier method and log-rank test were used to analyze the overall survival (OS), and chi-square analysis was used to analyze the association between T-CONUT and clinicopathological characteristics. The independent risk factors were analyzed by Cox regression. A nomogram was constructed by R studio. Calibration plots, the c -index, and decision curves were evaluated for the performance of the...

2023, Cureus

Idiopathic achalasia is a rare esophageal dysmotility disorder of unknown etiology with only palliative treatment available. Many studies have established a significantly increased risk of esophageal cancer in patients with achalasia. However, current guidelines advise against routine surveillance due to low absolute risk and a paucity of high-quality evidence and cost-effectiveness assessments. This review aims to assess the need for routine endoscopic surveillance in achalasia based on a growing body of literature calling in support of it, mainly due to the increased risk of esophageal cancer. We searched PubMed and Google Scholar electronic databases for articles within the last 10 years using the keywords 'achalasia', 'cancer,' 'neoplasms,' 'screening,' and 'surveillance.' After excluding pseudoachalasia/secondary achalasia, other esophageal dysmotility disorders, and associations with malignancies outside the esophagus, we selected 31 articles for this review. Through these articles, we identified areas of focus for ongoing and future research that may result in significant risk reduction of complications, including esophageal cancer and beyond.

2023, American Journal of Gastroenterology

The clinical relevance of manometric esophagogastric junction outflow obstruction can be determined using rapid drink challenge and solid swallows

2023, Rambam Maimonides Medical Journal

Achalasia is a chronic idiopathic disease characterized by the absence of esophageal body peristalsis and by defective lower esophageal sphincter (LES) relaxation. The incidence rate ranges from 1.07 to up to 2.8 new cases per year per 100,000 population. Presenting symptoms include dysphagia, regurgitation, vomiting, and weight loss. The diagnosis of achalasia has undergone a revolution in the last decade due to the advent of high-resolution manometry (HRM) and the consequent development of the Chicago Classification. Recent progress has allowed achalasia to be more precisely diagnosed and to be categorized into three subtypes, based on the prevalent manometric features of the esophageal peristalsis. Treatment options are pharmacotherapy, endoscopic management (Botox injection or pneumatic dilation), and surgery, e.g. laparoscopic Heller myotomy (LHM). More recently, a new endoscopic technique, per oral endoscopic myotomy (POEM), has developed as a less invasive approach alternative to the traditional LHM. Since the first POEM procedure was performed in 2008, increasing evidence is accumulating regarding its efficacy and safety profiles. Currently, POEM is being introduced as a reasonable therapeutic option, though Achalasia: Modern Diagnosis and Management

2023, American Journal of Clinical Pathology

A 76-year-old woman, an ex-smoker, presented with several months' history of gastroesophageal reflux disease (GERD), recent weight loss, and a 1-week-old history of lower gastrointestinal bleeding. Her symptoms of heartburn were persisting despite her daily intake of omeprazole 40 mg daily. There was no associated dysphagia to solids or liquids. She also had a known history of internal hemorrhoids. Her lab tests showed a hemoglobin of 12.2 g/dL and a hematocrit of 37.8. An upper gastrointestinal endoscopy and a colonoscopy were done. Endoscopy showed multiple large white plaques in the lower esophagus, while the colonoscopy confirmed internal hemorrhoids in her lower rectum. Esophageal biopsies taken during endoscopy revealed an undulating esophageal squamous mucosa with a compact surface hyperorthokeratosis and a prominent underlying granular cell layer. An abrupt transition was noted between the area of epidermoid metaplasia and adjacent uninvolved normal squamous mucosa. PAS stain was negative for fungal organisms. There was no evidence of any dysplasia or carcinoma. A diagnosis of esophageal epidermoid metaplasia or esophageal leukoplakia was given. Esophageal leukoplakia is a rare histological counterpart of oral leukoplakia occurring in mostly middle-aged women. The most common complaint is dysphagia although few others may present with GERD symptoms (as in our patient) or achalasia. Significant risk factors that are similar to those in oral leukoplakia include smoking and alcohol consumption. The usual endoscopic appearance is that of white patches of plaque-like mucosa. Because of the reported high rate of squamous dysplasia or rarely even squamous cell carcinoma in the adjacent esophageal mucosa, these patients need close endoscopic follow-up. Also endoscopic screening should focus not only on the area of leukoplakia but also adjacent mucosa to pick up early dysplasia and/or cancer.