501
|
Xu AA, Breeze JL, Jackson CCA, Paulus JK, Bugaev N. Comparative analysis of traumatic esophageal injury in pediatric and adult populations. Pediatr Surg Int 2019; 35:793-801. [PMID: 31076868 DOI: 10.1007/s00383-019-04481-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Distribution and outcomes of traumatic injury of the esophagus (TIE) in pediatric versus adult populations are unknown. Our study sought to perform a descriptive analysis of TIE in children and adults. METHODS We reviewed the National Trauma Data Bank (NTDB) for the years 2010-2015. Demographics, characteristics, and outcomes of pediatric (age < 16 years) and adult TIE patients were described and compared. RESULTS Among 526,850 pediatric and 3,838,895 adult trauma patients, 90 pediatric (0.02%) and 1,411 (0.04%) adult TIE patients were identified. Demographics and esophageal injury severity did not differ. Children were more likely to sustain blunt trauma (63% versus 37%), with the most common mechanism being transportation-related accidents, were less-severely injured (median ISS 14 versus 22), and had fewer associated injuries (79% versus 95%) and complications (30% versus 51%) (all p < 0.001). Children had shorter hospitalizations (median 5 versus 10 days) and were more likely to be discharged home (84% versus 64%) (both p = 0.01). In-hospital mortality did not differ significantly between children and adults (10% versus 19%, p = 0.09). CONCLUSION TIE in the pediatric population has unique characteristics compared to adults: it is more likely to be a result of blunt trauma, has lower injury burden, and has more favorable clinical outcomes.
Collapse
|
502
|
Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series. Ann Med Surg (Lond) 2019; 44:62-67. [PMID: 31316769 PMCID: PMC6611994 DOI: 10.1016/j.amsu.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Esophageal injuries are rare, life-threatening, events with an overall reported incidence of less than 3%. In rare cases, trauma due to blunt or penetrating injuries cause esophageal perforations, which account for less than 15% of all esophageal injuries. Materials and methods A case-series study was conducted to describe the outcomes and management of all the traumatic esophageal injuries at the Puerto Rico Trauma Hospital (PRTH) from 2000 through 2017. These cases were evaluated in terms of etiology of perforation, mechanism of injury and esophageal level. Results Sixteen patients were treated for esophageal injuries at the PRTH between 2000 and 2017. Of these patients, 15 (93.7%) were males with a median age of 24.5 years (16, 49). Regarding the etiology of the esophageal perforation, 2 (12.5%) patients suffered blunt esophageal trauma, and 14 (87.5%) patients had penetrating trauma to the esophagus. The most common mechanism of perforation was gunshot wound 10 (62.4%), followed by stab wound 4 (25.0%), and the least common were motor vehicle collision 1 (6.3%) and pedestrian injured by traffic 1 (6.3%). Regarding esophageal location, 9 (56.3%) patients presented cervical, 6 (37.5%) thoracic, and 1 (6.3%) abdominal injuries. Most patients 13 (81.3%) had a prompt diagnosis of traumatic esophageal perforation, while 3 (18.7%) patients had a delayed diagnosis. Only 2 (12.5%) deaths occurred among our 16 patients, including 1 (6.3%) in delayed diagnosed subjects. Conclusion Esophageal perforation is a life-threatening condition and should be treated urgently. An early diagnosis and prompt surgical treatment completed in the first 24-h is fundamental for a good outcome. Sixteen patients were treated for esophageal injuries at the PRTH. Two patients suffered blunt esophageal trauma and 14 patients had penetrating trauma to the esophagus. Most patients had a prompt diagnosis of traumatic esophageal perforation, while 3 patients had a delayed diagnosis. Regarding esophageal location, of the 16 patients, 9 presented cervical, 6 thoracic, and 1 abdominal esophageal injury. Only 2 deaths occurred among our 16 patients, including 1 in delayed diagnosed subjects.
Collapse
|
503
|
Hwang SH, Cho JW, Bae CH, Jang JS. Staged Surgical Treatment of Primary Aortoesophageal Fistula. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:182-185. [PMID: 31236381 PMCID: PMC6559190 DOI: 10.5090/kjtcs.2019.52.3.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
Abstract
Aortoesophageal fistula (AEF) is a rare and potentially fatal disease that causes massive gastrointestinal bleeding. Therefore, early diagnosis and treatment are essential to prevent mortality. Controlling the massive bleeding is the most important aspect of treating AEF. The traditional surgical treatment was emergent thoracotomy, but intraoperative or perioperative mortality was high. We report a case of a patient presenting with hematemesis who was successfully treated by a staged treatment, in which bridging thoracic endovascular aortic repair was followed by delayed surgical repair of the esophagus and aorta.
Collapse
|
504
|
Cheng Y, Zhou X, Xu K, Huang Q. Esophageal lymphangioma: a case report and review of literature. BMC Gastroenterol 2019; 19:107. [PMID: 31242868 PMCID: PMC6595566 DOI: 10.1186/s12876-019-1026-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphangioma of the esophagus is an exceedingly rare benign tumor. Herein, we reported a case of lymphangioma in the thoracic esophagus. CASE PRESENTATION The patient was a 48-year-old woman who presented to our hospital with a one-month history of dysphagia. Upper endoscopy revealed an esophageal submucosal lesion that was completely removed by endoscopic submucosal dissection. Pathologic examination of the resected specimen secured the diagnosis of lymphangioma. A review of the PUBMED indexed literature in English with the key words of esophagus and lymphangioma was carried out and the results were discussed. CONCLUSION Esophageal lymphangioma is a rare submucosal tumor and should be included in the differential diagnosis of esophageal submucosal tumors.
Collapse
|
505
|
Esophageal pneumatosis: Case report and review of literature. Clin Imaging 2019; 58:15-21. [PMID: 31228826 DOI: 10.1016/j.clinimag.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
Pneumatosis of the gastrointestinal tract is defined as presence of air in the wall of the gastrointestinal tract and can occur in any part of the gastrointestinal tract. It is most commonly seen in the intestine and very rarely in the esophagus. The exact pathogenesis is still unknown. It is managed primarily by conservative and non-surgical therapy, unless there are findings to suggest an acute abdomen or other co-morbidities. On review of literature, very few case reports of esophageal pneumatosis have been published. We present a rare case of pneumatosis of the esophagus with cytomegalovirus (CMV) infection.
Collapse
|
506
|
Abstract
Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.
Collapse
|
507
|
Gastroesophageal and Laryngopharyngeal Reflux Associated With Laryngeal Malignancy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:1253-1264.e5. [PMID: 30366155 DOI: 10.1016/j.cgh.2018.10.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastric reflux may lead to chronic mucosal inflammation and contribute to development of laryngeal malignancies, although there is controversy over this association. We performed a systematic review and meta-analysis to assess this relationship and determine the risk of laryngeal malignancy in patients with reflux disease. METHODS We performed a systematic review and meta-analysis, searching MEDLINE, EMBASE, and Web of Science databases from 1900 through April 9, 2018, for observational studies of adults reporting associations between gastroesophageal reflux disease (GERD) and/or laryngopharyngeal reflux and the risk of having or developing laryngeal malignancies. An itemized assessment of the risk of bias was conducted for each study that met inclusion criteria. The meta-analysis was performed using the Mantel-Haenszel method with random effects to account for heterogeneity. We performed subgroup analyses to determine the effect of reflux type, study design, diagnostic method, and confounding variables on the overall risk. RESULTS Of the 957 studies that were identified during systematic review, 18 case-control studies met the criteria for analysis. Our meta-analysis showed that reflux disease significantly increased the risk of laryngeal malignancy (odds ratio, 2.47; 95% CI, 1.90-3.21; P < .00001; I2 = 94%). This association remained when controlling for patient smoking and drinking (odds ratio, 2.07; 95% CI, 1.26-3.41). There was no statistically significant difference in risk of laryngeal malignancies between patients with GERD vs laryngopharyngeal reflux (P = .44). CONCLUSIONS In a systematic review and meta-analysis, we found a significant association between reflux disease and the presence of laryngeal malignancy. Prospective studies should be performed to examine this relationship.
Collapse
|
508
|
Di L, Fu KI, Wu X, Liu X, Xie R, Zhu R, Tuo B. Endoscopic features and associated histology of an basaloid squamous cell carcinoma of the esophagus at the very early stage. BMC Cancer 2019; 19:513. [PMID: 31142308 PMCID: PMC6542137 DOI: 10.1186/s12885-019-5749-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/24/2019] [Indexed: 01/18/2023] Open
Abstract
Background Basaloid squamous cell carcinoma of the esophagus (BSCCE) is generally detected at advanced stage and the prognosis is poorer than advanced conventional esophageal squamous cell carcinoma. Therefore, early detection is a critical to improve patients’ survival. However, only a few cases of early BSCCE have been reported and the endoscopic features of early BSCCE are not well described. We herein report the endoscopic features and associated histology of an early BSCCE limited within the mucosal lamina propria (m2). To our knowledge, this is the earliest BSCCE reported to date. Case presentation A 62-year-old male patient was admitted to our hospital because of epigastric pain for 3 months. White light endoscopy revealed a flat lesion with mild sloping at the periphery. The lesion was covered with leukoplakia, and normal vascular network could not be seen in the lesion. Magnifying endoscopy with narrow-band imaging showed abnormal intra-papillary capillary loop categorized as type B1 according to the classification of the Japan Esophageal Society. Iodine staining revealed a less-stained lesion. The lesion was completely resected through endoscopic submucosal dissection. Histopathologically, tumor cells, which were limited within the mucosal lamina propria, formed solid nests and lobule structures, with ribbon-like arrangement of sparse cytoplasm and round to ovoid hyperchromatic nuclei. A final diagnosis of early BSCCE was established. Conclusions This is the earliest BSCCE reported to date. The prominent lesion with a gentle rising slope and less-staining or abnormal stain might be initial feature of early BSCCE.
Collapse
|
509
|
Saleh T, Ahmed E, Yu L, Kwak HH, Kang BJ, Park KM, Choi KY, Kim BM, Kang KS, Woo HM. Characterization of silver nanoparticle-modified decellularized rat esophagus for esophageal tissue engineering: Structural properties and biocompatibility. J Biosci Bioeng 2019; 128:613-621. [PMID: 31128971 DOI: 10.1016/j.jbiosc.2019.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Abstract
Decellularized esophageal matrices are ideal scaffolds for esophageal tissue engineering. Unfortunately, in order to improve transplantation possibilities, they require modification to reduce their degradation rate and immunogenicity. To date, no modifying agent has been approved to overcome these limitations. The objective of this study was to evaluate the ability of silver nanoparticles (AgNPs) to improve the structural stability and biocompatibility of decellularized rat esophagi. AgNPs have the advantage over currently used agents in that they bind with collagen fibers in a highly ordered manner, via non-covalent binding mechanisms forming multiple binding sites, while other agents provide only two-point connections between collagen molecules. Rat esophagi were decellularized, loaded with 5 μg/mL of AgNPs (100 nm), and then treated with an immobilization-complex buffer composed of ethyl carbodiimide hydrochloride and N-hydroxysuccinimide (EDC/NHS). Then, they were evaluated in terms of ultra-structural morphology, water uptake, in vitro resistance to enzymatic and thermal degradation, indentation strength, in vitro anti-calcification, cytocompatibility with rat bone marrow derived stromal cells (rat-BMSCs), angiogenic properties, and in vivo biocompatibility, and compared to scaffolds modified using glutaraldehyde and EDC/NHS complex buffer alone. AgNP-modified scaffolds showed an improved ultrastructure, good water uptake, and considerable resistance against in vitro degradation and indentation, and a high resistance against in vitro calcification. Moreover, they were cytocompatible for allogeneic rat-BMSCs. Additionally, AgNPs did not alter the angiogenic properties of the modified scaffolds and decreased host immune responses after their subcutaneous implantation. The structural properties and biocompatibility of decellularized esophageal matrices could be improved by conjugation with AgNPs.
Collapse
|
510
|
Scott B, Cottreau J, Oviedo A, Arnason T. Ciliated columnar epithelium in the esophagus and gastroesophageal junction: A different perspective from study of a North American population. Ann Diagn Pathol 2019; 41:90-95. [PMID: 31200216 DOI: 10.1016/j.anndiagpath.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
An index case of ciliated columnar epithelium in a gastroesophageal (GE) junction biopsy identified in routine surgical pathology practice struck us as highly unusual. However, pathology literature, mainly from Asian populations, reports ciliated columnar epithelium in up to 40% of tissue samples from the upper GI tract. This was inconsistent with our pathology practice experience, so we initiated a local review of cases at our Canadian centre. 1048 consecutive tissue samples from the esophagus and GE junction were reviewed retrospectively and no ciliated epithelium was identified. This review included 1000× oil immersion microscopy of 22 cases with "multilayered epithelium". In 971 cases verified in prospective surgical pathology practice following identification of the index case, 3 additional cases of ciliated columnar epithelium were identified. The index case had ciliated pseudostratified columnar epithelium, resembling respiratory epithelium, and had strong, diffuse expression of TTF-1 by immunohistochemistry. In the other 3 cases, the cilia were located on the surface of a pseudostratified columnar epithelium, a multilayered epithelium, or a low columnar epithelium, all TTF-1 negative. Over a year later, the index case proved to have arisen from a bronchial-esophageal fistula. The other cases were not associated with a fistula. Our conclusion is that ciliated columnar epithelium is rare in Canadian adults (<0.5% of patients). Ciliated epithelium due to a bronchial-esophageal fistula is exceptional, but something to consider if there is a suspicious clinical picture and TTF-1 expression. Other cases might represent a rare metaplastic phenomenon or remnant from fetal development.
Collapse
|
511
|
Abstract
Gastrointestinal stromal tumors (GISTs) arise anywhere along the gastrointestinal tract, most commonly as a result of c-kit or PDGFRA proto-oncogene mutations. Surgical resection is an important component of treatment. However, molecular profiling of GISTs has provided many insights into adjuvant and neoadjuvant therapy options. Imatinib, the most frequently studied medical therapy, has been shown in numerous studies to provide benefit to patients in both the neoadjuvant and adjuvant setting. Interval imaging is an important component of the treatment of GISTs and national surveillance recommendations should be followed.
Collapse
|
512
|
Abstract
The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.
Collapse
|
513
|
Park JH, Song J, Cho C. Impacted dental bridge in the esophagus following general anesthesia: A case report. J Dent Anesth Pain Med 2019; 19:111-114. [PMID: 31065593 PMCID: PMC6502766 DOI: 10.17245/jdapm.2019.19.2.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
A dental bridge impacted in the esophagus of a 43-year-old man was successfully removed using endoscopy, without any further complications. It is of utmost importance that the medical staff carefully assess the patient's dental condition, provide clear documentation, and notify the patient appropriately to prevent dental prosthesis-related complications and claims. Anesthesiologists also need to be more cautious in the perioperative period, even after extubation, because this complication may not be completely avoidable.
Collapse
|
514
|
Abdallah J, George N, Yamasaki T, Ganocy S, Fass R. Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders. Clin Gastroenterol Hepatol 2019; 17:1073-1080.e1. [PMID: 29913281 DOI: 10.1016/j.cgh.2018.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/16/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
Collapse
|
515
|
Sarma A, Grant FD, Kwatra NS. Esophageal transit scintigraphy in children: a user's guide and pictorial review. Pediatr Radiol 2019; 49:663-677. [PMID: 30535870 DOI: 10.1007/s00247-018-4301-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/30/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
Technical and clinical aspects of esophageal transit scintigraphy in pediatric patients are reviewed via several illustrative cases that highlight its utility in evaluating primary and secondary esophageal motility disorders.
Collapse
|
516
|
Simić AP, Skrobić OM, Peško PM. A Surgeon's Role in the Management of Early Esophageal, EGJ and Gastric Lesions. Dig Dis 2019; 37:355-363. [PMID: 31030193 DOI: 10.1159/000500120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic mucosal resection and submucosal dissection (ESD) are indicated in a majority of mucosal esophageal, esophagogastric junction and gastric cancers (GC), and selected cases of submucosal cancers as well. SUMMARY The presence of lymph node metastases in early esophageal cancer (EC) has been proven in up to 50% of -patients with sm3 cancers treated with surgical resection, and up to 18.5 and 30.5% in sm1 and sm2 cancer respectively. The presence of lymphovascular invasion (LVI), tumor depth >500 μm and poor tumor differentiation seem to be a common predictor of worse outcomes in literature reports. In case of early esophagogastric junction cancer (EGJC) these predictors include LVI, tumor size >3 cm, Barrett's origin of the tumor and ulcerative tumor appearance. Extended indications for ESD in early GC are already adopted in high volume centers with high success rates (up to 98%). Jet, positive resection margins after ESD, LVI and poor tumor differentiation carry high metastatic potential, therefore advocating surgery. Limited resections and cooperative laparoscopic endoscopic approach may be implemented in cases of early EGJC and GC. Key Messages: The presence of LVI, depth of submucosal invasion, and poor tumor differentiation in cases of early EC, EGJC, and GC favor surgical treatment despite improvements in endoscopic techniques.
Collapse
|
517
|
Rosic Despalatovic B, Bratanic A, Puljiz Z, Bozikovic J. Esophageal Stenosis in a Patient with Lichen Planus. Case Rep Gastroenterol 2019; 13:134-139. [PMID: 31011313 PMCID: PMC6465741 DOI: 10.1159/000498907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/14/2019] [Indexed: 11/23/2022] Open
Abstract
Lichen planus is a chronic, idiopathic disorder which usually affects skin and mucosal surfaces. While oral mucosa is frequently involved, esophageal localization is uncommon, and it usually manifests with dysphagia. It has also been associated with squamous cell carcinoma. Underdiagnosing of esophageal lichen planus often leads to a delay in treatment. There are also no clear recommendations for treatment of this disorder. Systemic corticosteroids are usually the first-line therapy, but different other therapeutic approaches are also used, with a various rate of response. We present the case of a patient with esophageal lichen planus complicated with esophageal stenosis, who was rather resistant to treatment.
Collapse
|
518
|
Results of the different surgical options for the treatment of cancer of the esophagogastric junction: Review of the evidence. Cir Esp 2019; 97:445-450. [PMID: 31027834 DOI: 10.1016/j.ciresp.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/21/2022]
Abstract
There is significant controversy in the management of cardiac cancer. It seems unanimous that Siewert type I tumors be operated on as cancer of the esophagus and Siewert type III as gastric cancer. However, for "true" cancer of the gastric cardia or Siewert II, the authors do not agree. There is the obvious need for free proximal and distal margins, as well as correct lymphadenectomy. For some, esophagectomy is necessary to perform correct radical oncological surgery, but other authors defend that an abdominal approach is sufficient to perform total gastrectomy and distal esophagectomy. Recent and older papers published do not clarify this issue, and their results are contradictory. Chemotherapy prior to surgery can reduce the size of the tumor and the presence of lymphadenopathies.
Collapse
|
519
|
Liu BR, Liu D, Yang W, Ullah S, Cao Z, He D, Zhang X, Shi Y, Zhou Y, Chen Y, He D, Zhao L, Yuan Y, Li D. Mucosal loss as a critical factor in esophageal stricture formation after mucosal resection: a pilot experiment in a porcine model. Surg Endosc 2019; 34:551-556. [PMID: 30980136 DOI: 10.1007/s00464-019-06793-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/09/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Esophageal stricture is a major complication of large areas endoscopic submucosal dissection (ESD). Until now, the critical mechanism of esophageal stricture remains unclear. We examined the role of mucosal loss versus submucosal damage in esophageal stricture formation after mucosal resection using a porcine model. MATERIALS AND METHODS Twelve swine were randomly divided into two groups, each of 6. In each group, two 5-cm-long submucosal tunnels were made to involve 1/3rd of the widths of the anterior and posterior esophageal circumference. The entire mucosal roofs of both tunnels were resected in group A. In group B, the tunnel roof mucosa was incised longitudinally along the length of the tunnel, but without excision of any mucosa. Stricture formation was evaluated by endoscopy after 1, 2, and 4 weeks, respectively. Anatomical and histological examinations were performed after euthanasia. RESULTS Healing observed on endoscopy in both groups after 1 week. Group A (mucosa resected) developed mild-to-severe esophageal stricture, dysphagia, and weight loss. In contrast, no esophageal stricture was evident in group B (mucosa incisions without resection) after 2 and 4 weeks, respectively. Macroscopic examination showed severe esophageal stricture and shortening of esophagus in only group A. Inflammation and fibrous hyperplasia of the submucosal layer was observed on histological examination in both groups. CONCLUSION The extent of loss of esophageal mucosa appears to be a critical factor for esophageal stricture. Inflammation followed by fibrosis may contribute to alteration in compliance of the esophagus but is not the main mechanism of postresection stricture.
Collapse
|
520
|
Ben Safta Y, Souai F, Maatouk M, Zehani A, Mabrouk A, Daldoul S, Sayari S, Haout K, Ben Moussa M. Myxoid esophageal liposarcoma: A case report of a rare tumor. Int J Surg Case Rep 2019; 60:69-71. [PMID: 31207528 PMCID: PMC6580014 DOI: 10.1016/j.ijscr.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 11/22/2022] Open
Abstract
Esophagealliposarcoma represent a rare cause of esophagealtumor. We present a case of liposarcomain the low oesophagus treated by surgical resection. There is no conventional treatment of this pathology. The curative treatment requires surgical resection orendoscopic approach for selected tumor.
Introduction Esophageal liposarcoma represent a rare cause of esophageal tumor. According to the literature, since the first case reported in 1983, only 42 cases of esophageal liposarcoma were reported. Presentation of case We present a case of liposarcoma in the lower oesophagus treated by surgical resection. Discussion Liposarcoma in the oesophagus gastrointestinal tract is an uncommon. An analysis of the literature reports 42 cases.In many cases the diagnosis was established in postoperative period.Surgery is the standard treatment including polypectomy, total or subtotal oesophagectomy. Conclusion There is no conventional treatment of this pathology. The curative treatment requires surgical resection or endoscopic approach for selected tumor.
Collapse
|
521
|
Lin EC, Holub J, Lieberman D, Hur C. Low Prevalence of Suspected Barrett's Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms. Clin Gastroenterol Hepatol 2019; 17:857-863. [PMID: 30196157 PMCID: PMC6405322 DOI: 10.1016/j.cgh.2018.08.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Esophagogastroduodenoscopy (EGD) is frequently used to evaluate gastroesophageal reflux disease (GERD) without alarm symptoms, although the benefits are not clear. We aimed to determine the prevalence of uncomplicated GERD as an indication for EGD, the demographic characteristics of these patients, and the endoscopic outcomes of these procedures. METHODS We collected endoscopy data from a large national database of 543,103 EGDs performed at 82 sites from 2003 through 2014. We identified patients with GERD without alarm symptoms (dysphagia, bleeding, vomiting, or weight loss). Endpoints included the prevalence of endoscopically suspected Barrett's esophagus (sBE) and suspected long-segment BE (sLSBE), defined as ≥3 cm. RESULTS We found that 73,535 EGDs (13.5%) were performed for a primary indication of GERD without alarm symptoms: only 4122 patients (5.6%) had sBE, and of these, 24.2% had sLSBE. Significant risk factors for sBE and sLSBE included male sex, age, and white race. Other findings included peptic ulcers in 1337 patients (1.8%) and suspected tumors (47 esophageal, 42 gastric, 13 duodenal tumors, 2 others) in 101 patients. CONCLUSIONS In an analysis of a large cohort of patients undergoing EGD, uncomplicated GERD accounted for almost 14% of EGDs; within this population, only 23.6% were white men older than 50 years, who have an increased risk of BE and esophageal adenocarcinoma. The prevalence of sBE is lower than in prior time periods-this raises questions about the utility of EGD to detect BE in patients with uncomplicated GERD. Guidelines for management of uncomplicated GERD should account for these observations.
Collapse
|
522
|
Wang CY, Wen J, Zhou YH, Li S, Zhang Y, Lu W, Li J. [Predictive value for esophageal varices using acoustic radiation force impulse elastography in post-hepatitis B cirrhosis patients]. ZHONGHUA GAN ZANG BING ZA ZHI = ZHONGHUA GANZANGBING ZAZHI = CHINESE JOURNAL OF HEPATOLOGY 2019; 26:499-502. [PMID: 30317771 DOI: 10.3760/cma.j.issn.1007-3418.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: A retrospective analysis of the predictive value of acoustic radiation force impulse (ARFI) elastography for esophageal varices in post-hepatitis B cirrhosis patients. Methods: 124 patients with post-hepatitis B cirrhosis who were admitted to Tianjin Second People's Hospital from August 2016 to August 2017 were selected. According to the shape of esophageal varices under gastroscopy and the risk of bleeding, patients were divided into 4 groups, none, mild, moderate and severe. In ARFI mode, the VTQ function was used to detect the VTQ values of the liver and spleen. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the diagnosis of esophageal varices by VTQ values of the liver and spleen. Analysis of variance was performed on the data between the groups, and χ (2) test was performed for categorical data. Results: The difference in liver VTQ values between groups were statistically significant (F = 12.623, P < 0.01). There was a statistically significant difference in VTQ values between spleens (F = 9.022, P < 0.01). The liver VTQ predicts that the AUC value of mild esophageal varices in patients with cirrhosis was 0.701 (0.575-0.827); moderate varices was 0.802 (0.701-0.902); severe varices was 0.885 (0.784-0.986). The best cutoff value was 2.235, the specificity was 97.37%, the negative predictive value was 88.10%, and the accuracy was 90.16%. The VTQ value of spleen predicts the AUC value of mild esophageal varices in patients with liver cirrhosis was 0.688 (0.539-0.798); moderate varices were 0.762 (0.651-0.873); severe varices were 0.800 (0.671-0.928). The best cutoff value was 2.885, the specificity was 84.21%, and the negative predictive value was 82.05%. Conclusion: The application of ARFI elastography in the determination of VTQ values of liver and spleen has certain predictive value for esophageal varices and it might be useful for primary screening of esophageal varices in post-hepatitis B cirrhosis patients.
Collapse
|
523
|
Diagnosis using deep-learning artificial intelligence based on the endocytoscopic observation of the esophagus. Esophagus 2019; 16:180-187. [PMID: 30547352 DOI: 10.1007/s10388-018-0651-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The endocytoscopic system (ECS) helps in virtual realization of histology and can aid in confirming histological diagnosis in vivo. We propose replacing biopsy-based histology for esophageal squamous cell carcinoma (ESCC) by using the ECS. We applied deep-learning artificial intelligence (AI) to analyse ECS images of the esophagus to determine whether AI can support endoscopists for the replacement of biopsy-based histology. METHODS A convolutional neural network-based AI was constructed based on GoogLeNet and trained using 4715 ECS images of the esophagus (1141 malignant and 3574 non-malignant images). To evaluate the diagnostic accuracy of the AI, an independent test set of 1520 ECS images, collected from 55 consecutive patients (27 ESCCs and 28 benign esophageal lesions) were examined. RESULTS On the basis of the receiver-operating characteristic curve analysis, the areas under the curve of the total images, higher magnification pictures, and lower magnification pictures were 0.85, 0.90, and 0.72, respectively. The AI correctly diagnosed 25 of the 27 ESCC cases, with an overall sensitivity of 92.6%. Twenty-five of the 28 non-cancerous lesions were diagnosed as non-malignant, with a specificity of 89.3% and an overall accuracy of 90.9%. Two cases of malignant lesions, misdiagnosed as non-malignant by the AI, were correctly diagnosed as malignant by the endoscopist. Among the 3 cases of non-cancerous lesions diagnosed as malignant by the AI, 2 were of radiation-related esophagitis and one was of gastroesophageal reflux disease. CONCLUSION AI is expected to support endoscopists in diagnosing ESCC based on ECS images without biopsy-based histological reference.
Collapse
|
524
|
Voron T, Lintis A, Piessen G. Hybrid esophagectomy. J Thorac Dis 2019; 11:S723-S727. [PMID: 31080650 PMCID: PMC6503280 DOI: 10.21037/jtd.2018.12.92] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
Abstract
Esophagectomy is a complex surgical procedure associated with high rates of mortality and morbidity, mainly dominated by pulmonary complications. Minimally invasive approaches have been developed in order to decrease postoperative morbidity, including totally minimally invasive esophagectomy (MIE) and hybrid esophagectomy in which one surgical step is achieved either by laparoscopy or thoracoscopy and the other step by open approach. In this review, we will discuss the main results of this hybrid approach in esophagectomy for cancer. Hybrid esophagectomy is associated with better postoperative outcomes compared to open approach, and similar outcomes compared to totally MIE, especially concerning pulmonary complications. For long-terms outcomes, hybrid approach showed similar, or even better, overall survival than open approach. With a short learning curve, hybrid esophagectomy with laparoscopic gastric mobilization will be the future gold standard for esophagectomy and should be further compared with totally MIE.
Collapse
|
525
|
Barrett's esophagus is negatively associated with eosinophilic esophagitis in Japanese subjects. Esophagus 2019; 16:168-173. [PMID: 30327893 DOI: 10.1007/s10388-018-0648-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although both eosinophilic esophagitis (EoE) and Barrett's esophagus (BE) are considered to be associated with T helper (Th) 2-mediated immune responses, the association between EoE and BE is unclear. We investigated the clinical relationship between EoE and BE. METHODS We conducted a single-center retrospective observational study. The study included 95 patients with EoE and randomly selected age- and sex-matched controls who underwent esophagogastroduodenoscopy during a medical health check-up at Osaka City University in a ratio of 1:2 for comparison. We compared the clinical characteristics and the prevalence rate of BE, reflux esophagitis (RE), hiatal hernia, and atrophic gastritis between EoE patients and controls by univariate analysis. Furthermore, we performed multivariate logistic regression analysis to investigate the association of these factors with EoE. RESULTS On univariate analysis, the prevalence rate of BE was significantly lower in patients with EoE than in controls (2.1% vs. 13.2%; p = 0.00528). In contrast, the prevalence rate of RE was higher in EoE patients than in controls, but it was not statistically significant (absence and Grades A, B, and C: 74.7%, 18.9%, 5.3%, and 1.1% vs. 83.7%, 12.6%, 3.7%, and 0%; p = 0.193, respectively). Multivariate analysis showed that BE was negatively associated with EoE (odds ratio: 0.132; 95% confidence interval: 0.0302-0.573; p = 0.00686). CONCLUSIONS BE is negatively associated with EoE in Japanese subjects. The mechanism behind the inverse relationship between EoE and BE should be examined.
Collapse
|