bluuebunny/crossref_metadata_2025 huggingface dataset:
620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE
Authors: Peterson Kathryn , Genta Robert , Rasmussen Henrik , Youngblood Bradford , Kamboj Amol
Published: September 2021

Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms.

Methods

52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment.

Results

45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group.

Conclusion

In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.
630 IMPACT OF LOW SKELETAL MUSCLE MASS AND DENSITY ON OUTCOMES OF LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS TREATED WITH RADICAL RADIOTHERAPY
Authors: Wang Yuan , Yang Ningjing , Jia Hongyuan , Liang Long , Wu Lei , Wang Qifeng , Li Tao
Published: September 2021

Low skeletal muscle mass and density are independent predictors of clinical outcomes in multiple gastrointestinal cancers. However, its effect on the long-term survival of locally advanced esophageal cancer patients undergoing radical radiotherapy is still unclear.

Methods

Patients with stage II-III esophageal cancer undergoing radical radiotherapy, enrolled in a observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding overall survival (OS).

Results

165 patients (75.8% males, median age 63) were included, from March-2012 to September-2017. Before radiotherapy, 26.7% patients had low skeletal-muscle-mass and 23.0% patients had low skeletal-muscle-density. After radiotherapy, 40.6% patients had low skeletal-muscle-mass and 30.3% patients had low skeletal-muscle-density.The median OS of high skeletal-muscle-mass/density group was significantly higher than that of low skeletal-muscle-mass/density group before radiotherapy (28.7 vs 28.2 months, p = 0.041; 29.6 vs 16.9 months, p = 0.025). The median OS of high skeletal-muscle-mass/density group was also significantly higher than that of low skeletal-muscle-mass/density group after radiotherapy (30.3 vs 20.3 months, P = 0.012; 29.6 vs 17.2 months, p = 0.018).

Conclusion

Low skeletal muscle mass and density are associated with long-term outcome in patients undergoing radical radiotherapy. It is suggested that oncologists should pay more attention to the management of muscle mass and density of patients with esophageal cancer undergoing radiotherapy in order to improve their nutritional status and long-term survival.
637 ANALYSIS OF THE OUTCOMES OF HAND-SEWN COMPARED TO THE STAPLED ANASTOMOSIS AFTER TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Authors: Honório Fernanda , Filho João Emílio Pinheiro , Tristão Luca , Santos Clara , Datrino Letícia , Orlandini Marina , Serafim Maria Carolina , Tavares Guilherme , Tustumi Francisco , Dias André , Waisberg Jaques
Published: September 2021

The complications related to esophagojejunal anastomosis are among the leading issues in the postoperative period of total gastrectomy. This review aims to evaluate the surgical outcomes of hand-sewn esophageal anastomosis compared to mechanical anastomosis for the reconstruction of total gastrectomy.

Methods

A systematic review and meta-analysis of comparative studies evaluating hand-sewn and stapled anastomosis was performed.

Results

A total of 12 studies were selected, comprising 1761 individuals. The operation time was higher in the hand-sewn anastomosis group (mean difference [MD] = 22.13 minutes; 95%CI: 3.97, 40.29). However, the risk for anastomotic fistula was not different between the groups (difference risk [DR] = 0.00; 95%CI: −0.03, 0.03). Also, the rate of intracavitary abscess (DR = -0.02; 95%CI: −0.07, 0.02); the reoperation rate (DR = -0.00; 95%CI: −0.01, 0.01); postoperative complications (DR = 0.12; 95%CI: −0.01, 0.25); postoperative mortality (DR = 0.02; 95%CI: −0.02, 0.06); anastomotic stenosis (DR = -0.01; 95%CI: −0.03, 0.00); and length of hospital stay (mean difference [MD] = 3.52 days; 95%CI: −0.49, 7.53) were no different between groups.

Conclusion

The results indicate that the hand-sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time being.
642 PL02.01 DOES A HIGH MANDARD SCORE REALLY DEFINE A POOR RESPONSE TO CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA?
Authors: Knight William , Baker Cara , Griffin Nyree , Kelly Mark , Davies Andrew , Gossage James
Published: September 2021

A high Mandard score corresponds to a non-response to chemotherapy in the primary tumour in oesophageal adenocarcinoma. However, some patients experience tumour volume reduction and a nodal downstaging despite a high score. This study compares survival and recurrence patterns in these patients.

Methods

Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. CT estimated tumour volume change was examined in a subgroup of consecutive patients. Mean pre-chemotherapy and post chemotherapy tumour volumes were compared across Mandard groups and nodal responders.

Results

555 patients were included. Median survival was 55 months (Mandard 1,2,3) and 21 months (Mandard 4,5). In the Mandard 4,5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75% vs 28.74, systemic 24.59% vs 48.42%) and CRM positivity (22.95% vs 68.11). Complete nodal response independently predicted improved survival (HR 0.34(0.16–0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (−16.3 cm3 vs −7.7 cm3 p 0.033) with no significant difference between Mandard groups. Conclusion: Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.
652 LAPAROSCOPIC FUNDOPLICATION IS EFFECTIVE TREATMENT FOR PATIENTS WITH GASTROESOPHAGEAL REFLUX AND ABSENT ESOPHAGEAL CONTRACTILITY
Authors: Tran Steven , Gray Ronan , Kholmurdova Feruza , Thompson Sarah , Myers Jennifer , Bright Tim , Irvine Tanya , Watson David
Published: September 2021

Anti-reflux surgery in the setting of preoperative esophageal dysmotility is contentious due to fear of persistent long-term dysphagia, particularly in individuals with an aperistaltic esophagus (absent esophageal contractility). Emerging evidence suggests fundoplication is safe and effective in patients with esophageal dysmotility. This study aimed to determine the long-term postoperative outcomes following fundoplication in patients with absent esophageal contractility versus normal motility.

Methods

A case control study was performed, using a prospectively maintained database to identify all (40) patients with absent esophageal contractility on preoperative manometry who subsequently underwent fundoplication (36 anterior partial, 4 Nissen). Cases were propensity matched based on age, gender, and fundoplication type with another 708 patients who all had normal motility. Groups were assessed using prospective symptom assessment questionnaires to assess heartburn, dysphagia for solids and liquids, regurgitation, and satisfaction with surgery. Outcomes were compared at baseline and at 1, 5 and 10 years follow-up.

Results

Across follow-up to 10 years, no significant differences were found between the two groups for any of the assessed postoperative symptoms. Multivariate analysis found that patients with absent contractility had worse preoperative dysphagia (adjusted mean difference 1.09, p = 0.048), but postoperatively there were no significant differences in dysphagia scores at 5 and 10 year follow-up. No differences in overall patient satisfaction were identified across the follow-up period.

Conclusion

Laparoscopic anterior partial fundoplication in patients with absent esophageal contractility achieves acceptable symptom control without significantly worse dysphagia compared to patients with normal contractility. Patients with medically refractory reflux who have absent contractility should still be considered for surgical intervention.
670 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY
Authors: Inoue Seiya
Published: September 2021

Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009.

Methods

A total of 221 patients who underwent a sub total esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared.

Results

The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route reconstruction. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in RS route (p = 0.037).

Conclusion

The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD <13 mm.
695 METASTASIS OF THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODE AS PREDICTOR FOR CERVICAL LYMPH NODE DISSECTION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Leng Xue-feng , He Wenwu , Leng Xuefeng , Luo Qiyu , Mao Tianqin , Deng Xuyang , Han Yongtao
Published: September 2021

Lymph node(LN)metastasis is a common metastasis mode of esophageal squamous cell carcinoma (ESCC). The purpose of this study is to explore whether recurrent laryngeal nerve LNs metastasis can be used as a predictor of cervical LN dissection.

Methods

The postoperative pathological examination results of patients with ESCC who underwent three-field LN dissection in Sichuan Cancer Hospital from January 2010 to January 2016 were retrospectively collected to explore the relationship between the recurrent laryngeal nerve LN metastasis and cervical LN metastasis. At the same time, analyzed survival data to determine whether cervical LN dissection should be performed on patients with thoracic ESCC.

Results

Among all the study subjects, 53.3% (72/135) patients had metastasis in the thoracic recurrent laryngeal nerve LNs, and 36.3% (49/135) patients had metastasis in the cervical LN. 44.4% (32/72) Patients with metastasis in the thoracic recurrent laryngeal nerve LN tended to have a high incidence of cervical LN metastasis (P = 0.035). Subgroup analysis showed that 60% (81/135) patients had upper thoracic ESCC, and 46.9% (38/81) patients had cervical LN metastasis (P = 0.002). Survival analysis showed that patients with cervical LN metastasis had poor survival (P < 0.001). Multivariate analysis showed that bilateral recurrent laryngeal nerve LN metastasis was an independent risk factor for survial(P = 0.029).

Conclusion

Patients with bilateral recurrent laryngeal nerve LN metastasis in upper thoracic ESCC can be used as a predictor of cervical LN dissection.
696 LONG-TERM OUTCOMES OF MINIMALLY INVASIVE ESOPHAGECTOMY COMPARED TO OPEN ESOPHAGECTOMY: A RETROSPECTIVE ANALYSIS OF 2958 CASES IN SINGLE CANCER CENTER
Authors: Leng Xue-feng , Li Kexun , Wang Qifeng , He Wenwu , Liu Kun , Li Zhiyu , Zheng Kai , Luo Qiyu Qiyu , Li KunZhi , Mao Tianqin , Deng Xuyang , Luo Xi , Fang Qiang , Peng Lin , Han Yongtao
Published: September 2021

Esophageal cancer is the fourth primary cause of cancer-related death in the male in China.The cornerstone of treatment for resectable esophageal cancer is surgery. With the development of minimally invasive esophagectomy (MIE), it is gradually adopted as an alternative to open esophagectomy (OE) in real-world practice. The purpose of this study is to explore whether MIE vs. OE will bring survival benefits to patients with the advancement of treatment techniques and concepts.

Methods

Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database). We retrospective analyzed esophageal cancer patients who underwent esophagectomy from Jan. 2010 to Nov. 2017. Patients were divided into two groups: MIE and OE groups. Clinical outcome and survival data were compared using TNM stages of AJCC 8th edition.

Results

After 65.3 months of median follow-up time, 2958 patients who received esophagectomy were included. 1106 of 2958 patients (37.4%) were underwent MIE, 1533 of 2958 patients (51.8%) were underwent OE. More than half of the patients (56.7%, 1673/2958) were above stage III. The median overall survival (OS) of 2958 patients was 51.6 months (95% CI 45.2–58.1). The MIE group's median OS was 74.6 months compared to 42.4 months in the OE group (95% CI 1.23–1.54, P < 0.001). The OS at 1, 3, and 5 years were 90%, 68%, 58% in the MIE group; 85%, 54%, 42% in the OE group,respectively (P<0.001).

Conclusion

The nearly 8-year follow-up data from this single cancer center suggests that with the advancement of minimally invasive surgical technology, MIE can bring significant benefits to patients' long-term survival compared with OE. Following the continuous progression of minimally invasive surgery and establishing a mature surgical team, MIE should be encouraged.
714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW
Authors: Bull Charles , Pucher Philip H , Gossage James
Published: September 2021

The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery.

Methods

A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores.

Results

28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis.

Conclusion

Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.
718 DIFFERENCES BETWEEN INTRACORPOREAL AND EXTRACORPOREAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY: IS THERE A BETTER WAY?
Authors: Takeda F , Aissar Sallum R , Ribeiro U , Cecconello I , Nahas S
Published: September 2021

Introduction

Esophagectomy remains good option to curative intent for esophageal carcinoma. However, quality of life for post-operative symptoms such as reflux, gastric emptying delayed and dysphagia is on debate. Some studies advocate relations between those symptoms to gastric tube conformation and discrepancies between intra and extracorporeal gastric tube construction. We aimed to analyze differences between both methods.

Methods

During 2014–2020, patients underwent to esophagectomy by thoracoscopic approach with cervical anastomosis (McKeown procedure). The abdominal part was performed by totally laparoscopic (group A) or hybrid (group B) hand-assisted gastric tubulization. Clinical parameters, symptoms of reflux, gastric tube evaluated by tomography, post-operative endoscopic findings were assessed and compared between groups. Multivariable analysis was performed.

Results

36 group A and 56 group B, 55 (59.7%) were squamous cell carcinoma and 60 (66.6%) did neoadjuvant chemoradiotherapy. Mean follow-up was 32 months. Group A had more gastric tube diameter (p < 0.001), alimentary stasis (p < 0.001), redundant conformation (p < 0.05) and distant from axial central point of the thorax (p < 0.05); all evaluated by tomography. And also, more symptoms of reflux and gastric empty delay by reflux symptoms index (RSI) (p < 0.001); and numbers of esophagitis grade B and C by upper endoscopy (p < 0.01). After multivariable analysis, intracorporeal (p < 0.001) and diameter more than 4.2 cm (p < 0.01) was related to worst RSI.

Conclusion

The intracorporeal gastric tube reconstruction may lead wider gastric tube conformation, which might be related to gastric empty delay, resulting in intense reflux symptoms confirmed by upper endoscopy.
719 REDUCED MEAN NOCTURNAL BASELINE IMPEDANCE AIDS DIAGNOSIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE AND LARYNGOPHARYNGEAL REFLUX DISEASE
Authors: Park Jin-soo , Van der Wall Hans , Falk Gregory
Published: September 2021

Laryngopharyngeal reflux disease (LPR) and gastro-esophageal reflux disease (GERD) occur due to acidic gastric refluxate causing symptoms. Baseline esophageal impedance has been shown to be reduced with prolonged acid exposure. Mean nocturnal baseline impedance (MNBI) is a novel measure that has shown promise in GERD but has not been evaluated in LPR. This study aimed to assess the role of MNBI in LPR and GERD patients.

Methods

Off-therapy impedance-pH tracings were blindly reviewed for 187 patients previously prospectively allocated clinical diagnoses of LPR (n = 105) or GERD (n = 82). Conventional impedance-pH measures and MNBI were analysed for the two groups.

Results

MNBI was significantly lower in the distal esophagus in GERD patients compared with LPR (1679 ± 914 vs. 2109 ± 863; p = 0.001). Similarly, in the proximal esophagus, MNBI was lower in GERD than LPR (2289 ± 579 vs. 2541 ± 471; p = 0.001). In the pharynx, MNBI was similar between the two groups (2116 ± 699 vs. 2133 ± 770; p = 0.878). Distal acid exposure time (AET) and the number of distal acid reflux episodes negatively correlated with distal esophageal MNBI (r = −0.195; p = 0.007) and (r = −0.330; p < 0.001) respectively.

Conclusion

Baseline impedance was reduced in both LPR and GERD at both distal and proximal esophageal measurements, and more severely reduced in GERD. Baseline impedance is strongly and inversely related to acid exposure in the esophagus. Pharyngeal MNBI was not reduced or different between groups. Distal and proximal esophageal MNBI may be useful in diagnosis of LPR as well as GERD.
732 TUMOR INFILTRATING NEUTROPHILS ARE A POOR PROGNOSTIC MARKER FOR ESOPHAGEAL CANCER PATIENTS RECEIVING NEOADJUVANT CHEMORADIOTHERAPY
Authors: Cabalag Carlos , Prall Owen , Ciciulla John , Galea Laurence , Thio Niko , Chong Lynn , Hii Michael W , Neeson Paul J , Arnau Gisela Mir , Phillips Wayne A , Clemons Nicholas J , Duong Cuong P
Published: September 2021

Significant advances have been made in our understanding of the tumor immune microenvironment (TIM) and tumor infiltrating lymphocytes (TILs). Nevertheless, there is little understanding of the changes in the TIM in response to neoadjuvant chemoradiotherapy (CRT). Thus, our aim was to investigate the changes in the TIM with neoadjuvant CRT in EC by assessing the immune cell infiltrate, the expression of immune related genes, and their association with treatment response and prognosis.

Methods

To decipher the effects of neoadjuvant CRT on the TIM, we obtained 58 paired pre-treatment and post neoadjuvant CRT treated EC specimens. TILs and tumor infiltrating neutrophils (TIN) were quantified in pre-treatment biopsies and surgical resection specimens following neoadjuvant CRT. To evaluate the immune transcriptomics, RNA was extracted from these specimens and gene expression was assessed using the Nanostring Platform based on the PanCancer Immune Profiling Panel. Immunohistochemistry (IHC) was performed to validate findings from the immune transcriptomics.

Results

TIL counts were not prognostic for disease specific survival (DSS). We observed higher expression of immune-suppressive inflammatory chemokines (TGFß-1 and IL-16) in post-neoadjuvant treated samples compared to pre-treatment biopsies. In samples collected after neoadjuvant CRT, low expression of genes related to anti-tumor T cell cytotoxic activity1 was significantly associated with disease recurrence. In patients with residual disease, multivariate analysis revealed a high neutrophil count, but not TIL count, was significantly associated with inferior DSS (HR 3.8 [1.3– 10.8]; p = 0.01).

Conclusion

In EC, the tumor microenvironment after neoadjuvant CRT remains largely immune-suppressive. We discovered that the presence of TINs in patients with residual disease post neoadjuvant CRT is an independent adverse prognostic factor. Collectively, our results suggest that an inflammatory pro-tumoral microenvironment associated with TINs may contribute to treatment resistance and progressive disease in EC.
753 SCARLESS APPROACH FOR KILLIAN JAMIESON DIVERTICULUM: TRANSORAL ENDOSCOPIC ASSISTED ESOPHAGODIVERTICULOSTOMY
Authors: Samuel Tay , Denise Zhang , Voon Kelvin
Published: September 2021

Killian-Jamieson Diverticulum (KJD) is a rare variant of proximal esophageal diverticulum that arises from the Killian-Jamieson area (antero-lateral). It differs from the more common Zenkers diverticulum which usually arise from the posterior aspect of the proximal esophagus. The choice of surgical intervention for symptomatic KJD is still unclear due its rare incidence and surgeons still prefer the transcutaneous cervical approach. Here we present the transoral endoscopic assisted esophagodiverticulostomy approach and the relevant literature.

Methods

26 year old male presented with progressive dysphagia for the past two years. A Killian-Jamieson Diverticulum was diagnosed after an Oesophagogastroduodenoscopy and Barium swallow. Patient underwent a transoral endoscopic assisted esophagodiverticulostomy.

Results

The surgery was uneventful and no complications were observed post-operatively. A year after the surgery patient is asymptomatic and no sign of recurrence.

Conclusion

Transoral endoscopic assisted esophagodiverticulostomy is a safe approach for treatment of symptomatic KJD. In this era of minimally invasive surgery it should be considered when formulating a treatment approach based on its obvious advantages.
792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.
Authors: Van Der Wilk Berend , Hagens Eliza R C , Eyck Ben M , Gisbertz Suzanne S , Hillegersberg Richard , Nafteux Philippe , Schröder Wolfgang , Nilsson Magnus , Wijnhoven Bas P L , Lagarde Sjoerd M , Berge Henegouwen Mark I
Published: September 2021

To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy.

Methods

Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models.

Results

In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy.

Conclusion

Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.
796 OUTCOMES OF DELAYED SURGERY IN PATIENTS WITH RESIDUAL DISEASE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER
Authors: Overtoom Hidde , Eyck Ben , Wilk Berend , Noordman Bo , Sluis Pieter , Lagarde Sjoerd , Wijnhoven Bas , Lanschot Jan
Published: September 2021

Standard treatment for locally advanced oesophageal cancer is neoadjuvant chemoradiotherapy (nCRT), plus surgery 6-8 weeks later. Time to surgery (TTS) after nCRT seems safe up to 12 weeks, and possibly improves patient condition and pathological response. However, it is unknown whether prolonged TTS is safe in patients with residual disease. The aim of this study was to investigate whether prolonged TTS leads to inferior surgical outcomes and survival in patients with residual disease after nCRT.

Methods

Patients with pathologically confirmed residual disease 4-6 weeks after nCRT who underwent preoperative PET/CT and surgery were selected from the preSANO-trial and SANO-trial. Patients were stratified by TTS ≤12 weeks versus TTS >12 weeks after completion of nCRT. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), peroperative unresectability, microscopically radical resections (R0), tumour regression grade (TRG), postoperative complications and risk of distant dissemination. Effects of TTS on OS, PFS and distant dissemination were analysed with Cox regression, adjusted for Charlson comorbidity index (CCI) at baseline, as well as WHO performance score and weight loss after nCRT.

Results

Forty-two patients were included in the TTS >12 weeks and 132 patients in the TTS ≤12 weeks group. Median follow-up was 20.6 months (IQR 16.1-30.3). Adjusted hazard ratios for OS and PFS were 0.50 (95% CI: 0.24-1.02) and 0.47 (95% CI: 0.25-0.91), respectively, in favour of TTS >12 weeks. Patients with TTS >12 weeks had more postoperative complications (89% vs 72%, p = 0.049), but comparable peroperatively unresectable tumours (11.9% vs. 3.8%, p = 0.11), R0-resections (89% vs 87%, p = 0.89), and TRG-scores (p = 0.97) compared to patients with TTS ≤12 weeks. Patients with TTS >12 weeks showed less distant dissemination (HR 0.40, 95% CI: 0.18-0.88).

Conclusion

Prolonged TTS beyond 12 weeks in patients with clinically proven residual disease after nCRT did not have a negative effect on OS and on PFS, but was correlated with an increase in postoperative complications. The (non-significantly) better survival outcomes for TTS >12 weeks may be explained by the fact that patients had a lower risk of developing distant dissemination, which may reflect improved selection prior to surgery.
80 THE PROGNOSTIC FACTORS ASSOCIATED WITH LONG-TERM SURVIVAL IN THE PATIENTS WITH SYNCHRONOUS OLIGOMETASTATIC ESOPHAGEAL ADENOCARCINOMA
Authors: Iwatsuki Masaaki , Harada Kazuto , Baba Hideo , Ajani Jaffer
Published: September 2021

Patients with gastrointestinal cancer are increasingly being diagnosed with oligometastatic disease due to the development of sensitive imaging. Oligometastases (OLM) represent a clinical and anatomical manifestation of resistant localized cancer and/or metastases. However, oligometastatic disease is complicated by the lack of uniformity due to the heterogeneity of cancer, therefore, differing prognoses. The aim of this study is to identify the factors associated with long-term survival in the patients with synchronous oligometastatic esophageal adenocarcinoma (EAC).

Methods

Between 2002 and 2016, of 1400 patients with EAC (esophagus and Siewert types I and II) treated at our institute, 233 patients initially diagnosed with stage IVB were enrolled. OLM was defined as only metastasized to one organ and less than 5 metastases. We retrospectively analyzed the association between clinicopathological factors and prognosis, especially focused on the pattern of metastases.

Results

Eighty-five patients (36.5%) had OLM, and 148 (63.5%) had non-oligometastais (Non-OLM). The patients in OLM had significantly better overall survival (OS) than the patients in Non-OLM (p = 0.0001). Univariate analysis showed pattern of metastases (lymphatic OLM) and treatment method (consolidative local radiotherapy: CLT) were significantly associated with prognosis (p = 0.04 and 0.01). Multivariate analysis revealed that lymph node metastases (cN0-N1), number of metastasis (solitary) and treatment (CLT) were independent predictors for OS of patients with OLM. (p = 0.03, 0.01 and 0.001). In OLM patients, the patients with lymphatic OLM who received CLT had more favorable prognosis (5-years survival rate 25%).

Conclusion

This study suggests that CLT is one of the promising modalities for oligometastatic patients with EAC, especially the patients with lymphatic OLM.
811 WHETHER 10 WATER SWALLOWS NECESSARY TO OBTAIN REPRODUCIBLE RESULTS OF HIGH-RESOLUTION OESOPHAGEAL MANOMETRY?
Authors: Morozov Sergey , Kropochev Vasily , Artemov Alexey
Published: September 2021

Not less than ten wet swallows assessment in the primary test position is recommended by Chicago classification 4.0 for high-resolution oesophageal manometry (HREM); however, the required number of measurements are not sufficiently supported.

Aim

to evaluate the number of wet swallows necessary for correct interpretation of the results of lower esophageal sphincter integrated relaxation pressure (IRP) with low probability of type I and II errors.

Methods

Patients referred to perform HREM were enrolled. Solid-state 10Fr catheter and Solar (Laborie) software were used. Minimum 10 swallows by 5 mL water were obtained. These were analysed for cumulative means of IRP after 1…9 measurements. Conclusion made at each moment was compared with one based on 10 measurements. The results were characterized as true/false positive/negative for calculation of diagnostic accuracy. To exclude sample influence, Monte-Carlo simulation of sequential decision-making was performed with the use of sequential probability ratio test. Association of the diagnostic accuracy from recall was studied with the use of receiver operating characteristic curve (ROC) analysis.

Results

One hundred subjects were enrolled (25 with disorders of EGJ outflow). During the simulation, the probability of matching the decisions based on the 10 measurements and lower number of them was high. ROC analysis showed that actual probability to obtain false-positive results was twice as lower then ‘allowed’ rate of 5%. The probability to make false-negative results did not exceed 10% in any number of measurements. The probability that the conclusions made after 2 and after 10 measurements match was 0.9584 in those with disorders of EGJ outflow and 0.9652 in those without (figure 1).

Conclusion

The standard number of measurements required to support the presence of disorders of EGJ outflow during evaluation of 5 mL wet swallows in the primary position is excessive. Values of the IRP after 2 swallows allows to make similar decision to that after 10 swallows with >95% probability. This allows to reduce the number of wet swallows to assess in the primary position and save time for assessments in alternative position or perform provocation tests.
820 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND PRECANCEROUS LESIONS
Authors: Liu Yuzhi
Published: September 2021

With the development of endoscopic technology, endoscopic mucosal dissection (ESD) has become one of the standard treatments for superficial esophageal squamous cell carcinoma and precancerous lesion (SESCC-PL). However, the efficacy and safety of ESD in some special SESCC-PL patients is still unclear. The purpose of this study was to analyze the efficacy and safety of ESD in patients with SESCC-PL, especially for some special patients.

Methods

Firstly, according to the depth of lesions, all patients were divided into three groups: the epithelium and lamina propria group (M1-M2), the muscularis mucosae and submucosal superficial layer group (M3-SM1) and the submucosal deep layer group (≥SM2). Secondly, according to the age of patients, all patients were divided into two groups: elderly group (≥ 65 years old) and non-elderly group (<65 years old). Finally, all patients were divided into two groups: patients with liver cirrhosis group and patients without liver cirrhosis group. The efficacy and safety of ESD for these patients were analyzed.

Results

There was no significant difference in operation time, resection speed, en bloc resection rate, bleeding rate, muscularis propria injury rate, perforation rate and intraoperative esophageal stricture rate in three groups with different depths of lesion. However, the R0 resection rate among the three groups decreased with the increase of lesion depth (P < 0.001). There was no significant difference in all surgical indexes between the non-elderly group and the elderly group (all P > 0.05). And there was also no significant difference in all surgical indexes including bleeding rate between the patients with liver cirrhosis and without liver cirrhosis (all P > 0.05).

Conclusion

This study proved that ESD is safe and effective for all kinds of patients with SESCC-PL, especially for patients with lesion depth ≥ M3, elderly patients and patients with liver cirrhosis, ESD can still achieve a satisfactory treatment effect and a good survival prognosis. Liver cirrhosis is not a contraindication to ESD.
822 HOW THE OPERATING SURGEON'S ASSESSMENT OF RADICALITY INFLUENCES SURVIVAL AFTER ESOPHAGEAL CANCER SURGERY
Authors: Linder Gustav , Lindblad Mats
Published: September 2021

The operating surgeon’s assessment of surgical radicality following esophagectomy is reported to the Swedish National Registry for Esophageal and Gastric cancer(NREV). The variable provides means to identify risk factors for non-curative resections and study whether the surgeon’s assessment independently prognosticates survival.

Methods

All patients in NREV undergoing esophagectomy between 2006–2018 was grouped according to the surgeon’s assessment of radicality: Curative-, Borderline-curative- and Palliative resection. The cohort was followed until death, emigration or end of follow-up. Factors affecting group allocation was studied with multivariable logistic regression and survival with cox-regression and the Kaplan–Meier method.

Results

Of 1860 resected patients, esophagectomy was deemed curative in 1515(81%), borderline-curative in 179(10%), palliative in 63(3%) and missing in 103(6%). Median survival was 44.6, 20.0, 11.5 and 29.6 months respectively. Advanced stage (e.g., stage IVa), OR 7,37 (1,93–28,1 95%CI) and blood-loss >1000 mL, OR 1.90 (1,17-3,08), increased the risk of borderline-curative resection. Minimally invasive surgery and multidisciplinary treatment decision (MDT) decreased the risk of borderline-curative resection, OR 0.42 (0,23-0,77) and OR 0.41 (0,22-0,77). Adjusted for well-established prognostic factors, e.g. age, p-TNM and R1-resection, the surgeon’s assessment was an independent variable for survival; borderline-curative HR 1,38 (1,11-1,72), palliative HR 1,91 (1,38-2,63).

Conclusion

The surgeon’s operative assessment of radicality following esophagectomy appears to independently prognosticate survival. Advanced stage and large-volume intraoperative blood loss increases the risk while minimally invasive surgery and MDT decreases the risk for borderline-curative resection.
9 SURGICAL TECHNIQUES AND POTENTIAL OF MEDIASTINAL LYMPHADENECTOMY IN ROBOTIC SURGERY
Authors: Oshikiri Taro , Takiguchi Gosuke , Urakawa Naoki , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Nakamura Tetsu , Suzuki Satoshi , Kakeji Yoshihiro
Published: September 2021

Procedure of minimally invasive esophagectomy in prone position (Conventional prone-MIE) is standardized leading to feasible short outcomes. On the other hand, robot assisted MIE (Robotic MIE) was approved as Japanese health insurance treatment since 2018. Especially, reduction of recurrent laryngeal nerve (RLN) palsy leading to aspiration pneumonia is expected for Robotic MIE. The purpose of this study is to clarify the potential of Robotic MIE for improvement of short outcomes.

Methods

Twenty-four Robotic MIEs in introduction period since 2018 and 128 Conventional prone-MIEs in established period since 2015 from all of the 375 cases were compared using propensity score matching.

Results

Operative times in both entire and thoracic procedures were significantly longer in Robotic MIE. There were no significant differences between two groups in the number of harvested lymph nodes, amount of the blood loss, left RLN palsy rate (13% vs 14%, > Clavien-Dindo classification: C-D grade I), right RLN palsy rate (4% vs 8%, > C-D grade I), and pneumonia rate (7% vs 7%, > C-D grade II).

Conclusion

Short outcomes of Robotic MIE in introduction period were not inferior to those of Conventional prone-MIE in established period. More improvement is expected for Robotic MIE via learning curve. In conclusion, Robotic MIE has hidden potential to outstrip Conventional prone-MIE in outcomes.

Video

https://www.dropbox.com/s/7byc8nsqupgetsp/2020%20ISDE%20movie%20for%20submission.wmv?dl=0.
Indicative bacterial communities and taxa of disease-suppressing and growth-promoting composts and their associations to the rhizoplane
Authors: Mayerhofer Johanna , Thuerig Barbara , Oberhaensli Thomas , Enderle Eileen , Lutz Stefanie , Ahrens Christian H , Fuchs Jacques G , Widmer Franco
Published: September 2021

Compost applications vary in their plant growth promotion and plant disease suppression, likely due to differences in physico-chemical and biological parameters. Our hypothesis was that bacteria are important for plant growth promotion and disease suppression of composts and, therefore, composts having these traits would contain similar sets of indicative bacterial taxa. Seventeen composts prepared from five different commercial providers and different starting materials were classified accordingly with bioassays using cress plants and the pathogen Pythium ultimum. Using a metabarcoding approach, bacterial communities were assessed in bulk composts and cress rhizoplanes. Six and nine composts showed significant disease suppression or growth promotion, respectively, but these traits did not correlate. Growth promotion correlated positively with nitrate content of composts, whereas disease suppression correlated negatively with factors representing compost age. Growth promotion and disease suppression explained significant portions of variation in bacterial community structures, i.e. 11.5% and 14.7%, respectively. Among the sequence variants (SVs) associated with growth promotion, Microvirga, Acinetobacter, Streptomyces, Bradyrhizobium and Bacillus were highly promising, while in suppressive composts, Ureibacillus,Thermogutta and Sphingopyxis were most promising. Associated SVs represent the basis for developing prediction tools for growth promotion and disease suppression, a highly desired goal for targeted compost production and application.
Developing critical appraisal and evidence synthesis skills in future microbiologists
Authors: Flynn Matthew F
Published: September 2021

The Covid-19 pandemic has demanded modifications to undergraduates’ learning experiences and promised a more challenging scientific world in which they will live. Bespoke evidence synthesis and critical appraisal skills modules are an opportunity to utilize our information-saturated world to our advantage. This program of study made use of a virtual journal club, structured literature searches, scoping review methods and a variety of online research tools to navigate and critique the literature. The program design is here outlined with sample learning objectives and reference to the resources used.
Limosilactobacillus caccaesp. nov., a new bacterial species isolated from the human gut microbiota
Authors: Lo Cheikh Ibrahima , Dione Niokhor , Mbaye Aminata , Gómez Patricia Fernández-Mellado , Ngom Issa Isaac , Valles Camille , Alibar Stéphane , Lagier Jean-Christophe , Fenollar Florence , Fournier Pierre-Edouard , Raoult Didier , Diene Seydina M
Published: September 2021

Strain Marseille-P3519T isolated from the fecal flora of a 25-year-old healthy French woman was a Gram-positive anaerobic bacterium, non-motile and non-spore forming. The 16S rRNA gene sequence of Marseille-P3519 showed 97.73% of sequence similarity with Limosilactobacillus reuteri DSM 20016, the closest species, phylogenetically. Furthermore, the average nucleotide identity of strain Marseille-3519 with its closest related species was 75.8% that was very below the recommended threshold (>95–96%). Its genome had 2 237 367 bp with 45.42 mol% of G + C content. Major fatty acids were C16:0 (50.8%), C18:1n9 (18.0%), C18:2n6 (9.8%) and C19:1n9 (8.9%). It was catalase negative and fermented glycerol, glucose, fructose, D-maltose, lactose and mannose. These findings support that strain Marseille-P3519 ( = CSURP3519 = CECT 30110) is a new member of the genus Limosilactobacillus for which the name Limosilactobacillus caccae sp. nov., is proposed.
Impact of a training session for prescribers on the relative prescription of cefotaxime over ceftriaxone in elderly patients
Authors: Durand Amaury , Cayeux Sarah , Bloch Frédéric , Dupont Hervé , El Samad Youssef , Mary Aurélien , Hamdad Farida
Published: September 2021

Background

The prescription of ceftriaxone should be limited to patients with biliary tract infections and those lacking intravenous access. A specific training session for prescribers about the clinical relevance and economic value of prescribing cefotaxime instead of ceftriaxone might decrease the use of the latter in geriatric medicine.

Objectives

To determine the clinical and economic impact of a training session for prescribers on the subsequent prescription of third-generation cephalosporin, that is, the percentage of appropriate prescriptions and the cost of third-generation cephalosporin administration before and after the training session.

Methods

In a preliminary observational quasi-experimental, open-label study, appropriateness of cefotaxime and ceftriaxone prescription over a 4-week period immediately before the training session were compared with those during a 4-week period immediately afterwards.

Key findings

For 46 patients (29 before the training session and 17 afterwards), the proportion of cefotaxime prescriptions increased (from 3% to 35%; P = 0.007), and the proportion of appropriate prescriptions increased at the start of treatment (from 45% to 76%; P = 0.064) and at the end (from 76% to 88%; P = 0.450). The daily per-patient cost of treatment was €8 for cefotaxime and from €1.63 to €3.42 for ceftriaxone, depending on the administration route.

Conclusions

A training session for prescribers was associated with a decrease in ceftriaxone prescriptions encouraging further studies to improve the training session and then evaluate medico-economic impact through randomized clinical trials.
Highly Potent SARS-CoV-2 Neutralization by Intravenous Immunoglobulins manufactured from Post-COVID-19 and COVID-19-Vaccinated Plasma Donations
Authors: Karbiener Michael , Farcet Maria R , Schwaiger Julia , Powers Nicholas , Lenart James , Stewart Joseph M , Tallman Hema , Kreil Thomas R
Published: September 2021

From September 2020, some immunoglobulin lots from US plasma contained neutralizing antibodies against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Paralleled by the increasing numbers of post–coronavirus disease 2019 (COVID-19) donors, immunoglobulin lot antibody positivity increased to 93% by January 2021, at a mean titer of approximately 30 IU/mL. The correlation predicted that anti–SARS-CoV-2 potency would reach 345 IU/mL by July 2021. In addition to post–COVID-19 donors, the rapidly increasing number of plasma donors vaccinated against COVID-19 resulted in a mean antibody titer of >600 IU/mL in July 2021 immunoglobulin lots, with SARS-CoV-2 antibody titers for several lots even higher than those of earlier produced hyperimmune globulin products.