bluuebunny/crossref_metadata_2025_split huggingface dataset:
453 LAPAROSCOPIC RESECTION OF A GIANT EPIPHRENIC DIVERTICULUM
Authors: Ramos D , Priego P , Blazquez L , Cuadrado M , Sanchez S , Galindo J 
Published: September 2020

Abstract

Epiphrenic diverticula are acquired mucosal out-pouchings of the distal third of the oesophagus; vastly undiagnosed due to their usual asymptomatic status, with limited number in all published series, and a still ongoing debate both in their surgical indication and technique. This video shows all steps we think that are necessary when operating an epiphrenic diverticulum, in order to illustrate them all and to show the feasibility of performing such operation with minimally invasive procedures.

Methods
A 52-year-old male was diagnosed of a symptomatic giant epiphrenic diverticulum after previous complaints of dysphagia and regurgitation of undigested food. Preoperative barium-swallow and upper endoscopy confirmed the diagnosis, excluding any other secondary aetiology, and conventional oesophageal manometry did not show any relevant findings.

Results
Surgery was indicated for symptomatic disease, and a laparoscopic procedure was performed, with pneumoperitoneum created through a Veress needle and trocars placed similar to those used for a hiatal hernia repair. After opening the hiatus, access was granted to the mediastinum and the diverticulum was identified and dissected, and when its neck was completely exposed, diverticulectomy was performed using endostapler loads reinforced with Peri-strips Dry®. Aferwards, both an oesphageal myotomy (from the oesophago-gastric junction to the distal point of the diveticulum’s neck) and a partial Dor fundoplication (despite the absence of relevant findings in the conventional manometry) were performed.

Conclusion
Surgical management of epiphrenic diverticula should entail both resection of the pouch (diverticulectomy, to avoid postoperative persistent symptoms) and treatment of the underlying motility disorder that has been demonstrated in other studies in nearly 100% of the patients using high-resolution manometry (myotomy and fundoplication, both to avoid recurrences and leakages of the staple line). The laparoscopic approach is feasible without video-assisted thoracoscopy in diverticula with their neck up to 10 cm from the oesophagogastric junction.

Video
https://www.dropbox.com/s/hugbemgi6wl55kp/EpiphrenicDiverticulumx2.mp4?dl=0
462 DEFINING IMPACT OF PRE-OPERATIVE ANAEMIA ON SURVIVAL IN OESOPHAGOGASTRIC CANCER: A MULTI-INSTITUTIONAL ANALYSIS
Authors: Kamarajah S , Khaw R , Chmelo J , Navidi M , Phillips A 
Published: September 2020

Abstract

Growing interest surrounding pre-operative anaemia in patiens undergoing major surgery. However, no current evidence surrounding role of pre-operative anaemia on the post-operative outcomes and long-term survival following esophagectomy for esophageal cancers. This study aimed to evaluate morbidity and mortality according to pre-operative in patients undergoing esophagectomy for esophageal cancer.

Methods
Consecutive patients undergoing esophagectomy for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between January 2000 and December 2018 at the Northern Oesophagogastric Unit were included from a prospectively maintained database. The main explanatory variable is pre-operative anaemia. Primary outcome was overall survival. Secondary outcomes include overall complications, anastomotic leaks and pulmonary complications.

Results
During the study period, 1148 patients underwent esophagectomy for cancer. Of these 7% (n = 78) had pre-operative anaemia. Median survival of patients with anaemia were similar to those without pre-operative anaemia (median: 67 vs 45, p = 0.1). On Cox multivariable regression analysis, pre-operative anaemia had no impact on long-term survival, even when stratified for oesophageal adenocarcinoma and squamous cell carcinoma. Rates of overall complications (71% vs 66%), anastomotic leaks (4% vs 8%) and pulmonary complications (19% vs 14%) were similar between the groups.

Conclusion
Contrary to published evidence in cardiothoracic and vascular surgery, pre-operative anaemia had no impact on long-term survival and post-operative outcomes for esophagectomy.
76 WHOLE-EXOME SEQUENCING EXPLORES DIFFERENTIAL GENES EXPRESSION OF METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PROPENSITY-SCORE MATCHING STUDY
Authors: Zeng Y , Liu M , Xiang C , Yu J , Han Y , Li Z , Fu X , Cai X 
Published: September 2020

Abstract

Metastasis is the most popular failure pattern for esophageal squamous cell carcinoma (ESCC) patients. There were rare ESCC patients with stage T1-3N0M0 metastasized within 1 year after surgery or stage T1bN3M0, while many ESCC patients with stage T1-3N0M0 didn’t metastasize within 2 years after surgery or stage T1bN0M0. This study is to analyze paired ESCC patients with or without early distant metastasis or multiple lymph nodes, and identify potential biomarkers for early metastasis of ESCC.

Methods
1942 ESCC patients who underwent surgery in our institution were retrospectively reviewed from January 2013 to December 2017. One group of patients with stage T1-3N0 who developed metastasis within one year and without recurrence within two years after surgery (M group), and another group of patients with stage T1bN0 and T1bN3 (N group) were screened. We matched patients with the critically clinicopathological factors by propensity-score matching (PSM) method. Whole-exome sequencing (WES) was performed on the formalin-fixed paraffin embedded samples of the included patients. Statistical analysis was performed by SPSS version 22.0.

Results
From 1942 patients screened, there were only 6 T1-3N0 patients with early distant metastases and 4 T1bN3 patients. We paired 6 T1-3N0 patients without recurrence within two years and 4 T1bN0 patients by PSM. The median overall survival (mOS) of patients in M1 was 21 months, while M0 did not reached. The mOS of patients in N3 and N0 were 10 months and 48 months, respectively. The WES result showed that the FRG1, HLA-DRB1 and MUC6 expressed differentially in these patients. However, only the HLA-DRB1 expression was associated with the survival of patients in N group by univariate analysis (p = 0.013).

Conclusion
Regardless of the small sample size, the study identified several genes correlated with the early metastasis of ESCC. ESCC patients with T1bN3M0 had significantly higher expression of HLA-DRB1 gene than patients with T1bN0M0 (p = 0.013). It seemed that HLA-DRB1 gene was correlate with early multiple lymph nodes metastases, which needs further research and may be helpful in new drug discovery.
485 MINIMALLY INVASIVE EN-BLOC OESOPHAGECTOMY: ANALYSIS OF THE OUTCOMES ALONG A LEARNING CURVE
Authors: Di Maggio F , Lee A , Vrakopoulou Z , Deere H , Botha A 
Published: September 2020

Abstract

Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers. We wanted to investigate whether the peri-operative benefits of minimally invasive techniques, along with en-bloc resection of the primary tumour, translate into long term survival benefit in a specialized high volume center along a surgeon learning curve.

Methods
Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. 45 patients had open surgery; laparoscopy (n = 50) was initiated after two years, and thoracoscopy (n = 56) introduced after case 94. MIO was performed for the last 47 patients.
Patients in all groups had similar demographics, histological diagnosis, preoperative and pathological staging.

Results
158 patients were male (79.8%); age was 63 +/− 10 years. Overall five-year survival rate was 45%; perioperative mortality rate was 1.5% (n = 3); 13 patients were returned to theatre. Hospital stay was 22+/−23 days. Specimen lymph nodes were 21+/− 8. Resection margins were negative (ACP) in 193 cases (97.4%).
Five-year survival rates during the 4 phases were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p = 0.03).
Specimen lymph nodes were: open = 20.5+/−9.5; Lap = 19.5+/− 7; mini-tho = 19.9+/− 7; MIO = 25+/− 10 (p = 0.027). Resection margins were &gt; 1 mm in 68.1%(open), 67.3%(lap), 64.2%(mini-tho) and 79.5(MIO).

Conclusion
Laparoscopic en-bloc resection of cancers of the OGJ requires a long learning curve. Proficiency gains along this learning curve affects oncological quality of oesophageal resectional surgery and benefits patients survival after minimally invasive oesophagectomy.
489 A COMPREHENSIVE ANALYSIS OF ANASTOMOTIC COMPLICATIONS FOLLOWING ESOPHAGECTOMY
Authors: Katz A , Bendayan S , Hilzenrat R , L Ramirez-GarciaLuna J , Kammili A , Al Lawati Y , Abureida F , Nevo Y , Cools-Lartigue J , Spicer J , Mueller C , Ferri L 
Published: September 2020

Abstract

Post-esophagectomy anastomotic complications can result in high morbidity/mortality. Those with necrosis and sepsis have traditionally resulted in conduit loss and cervical esophagostomy. We sought to examine our management and outcomes of anastomotic complications, with a focus on an approach that stresses conduit salvage.

Methods
Conduit complications were identified from a prospectively collected esophagectomy database (2006–17) at a high-volume referral center. Patient/tumor/treatment details and surgical outcomes were collected. Conduit complications were defined as Leak/Conduit Necrosis/Tracheoesophageal Fistula (TEF) and graded according to the Clavien-Dindo classification. Successful treatment was defined when sepsis/leak control was achieved and no further intervention was required. Statistical analysis was done using Cox regression, logistic regression, ANOVA or Chi-square tests, *p &lt; 0.05.

Results
Of 647 esophagectomies, conduit complications occurred in 103 (16%) [Leak:73 (11%); Necrosis:24 (4%), (TEF):6(1%)]. Antibiotics (C-D = 2) was successful in 28 (38%) of Leaks. Endoscopic stent alone (C-D = 3A) was successful in 20 (27%) Leak, 7(29%) Necrosis, and 1(17%) TEF cases. Early conduit revision+re-anastomosis (C-D = 3B/4) was successfully performed in 22 (30%) Leak, 13 (54%) Necrosis, and 5(83%) TEF cases. Only 6 patients [2(3%) Leak, 4(16%) Necrosis] had conduit loss+cervical esophagostomy. 90-day mortality was: Minor (C-D = 2-3A) Leak = 3%, Major (C-D = 3B-4) Leak = 8%, and Necrosis = 21%*. Necrosis, but not Leak or TEF, was associated with lower 3-year survival compared to patients who did not have conduit complication (30% vs 55%, p &lt; 0.008).

Conclusion
The vast majority of conduit complications, including conduit necrosis, can be managed successfully with conduit salvage with endoscopic treatment or early surgical re-anastomosis. Cervical esophagostomy is rarely required.
494 LONG-TERM SYMPTOM CONTROL FOLLOWING LAPAROSCOPIC HELLER MYOTOMY AND DOR FUNDOPLICATION FOR ACHALASIA
Authors: Doubova M , Gowing S , Robaidi H , Gilbert S , Maziak D , Shamji F , Sundaresan S , Villeneuve P , Seely A 
Published: September 2020

Abstract

Achalasia is a primary esophageal motility disorder in which there is incomplete relaxation of the lower esophageal sphincter and absence of peristalsis in the lower two-thirds of the esophagus. A favored treatment is with laparoscopic modified Heller myotomy with Dor fundoplication (LHMDor) with over 90% beneficial effect. The short-term outcomes of LHMDor are well documented, but stability and durability of post-operative symptom control over time is less understood.

Methods
Between 2004–2016, 54 patients with achalasia underwent LHMDor (single center). Using validated questionnaires, patients rated their symptoms in five domains: pain, gastroesophageal reflux disease (GERD), dysphagia, regurgitation and quality of life (QOL), rating their symptoms preoperatively, 4-weeks post-operatively, 6-months post-operatively and yearly following the operation.

Results
As expected, patients reported marked improvement in dysphagia, odynophagia, regurgitation, GERD and quality of life after the operation (p &lt; 0.001). From then on, the symptom control remained durable with respect to absence of pain, regurgitation and odynophagia; however, we observed a recurrence of GERD symptoms beginning 3–5 years postoperatively (p = 0.001, p = 0.04, respectively), with associated increased antacid use. Following initial LHMDor, 5 patients required endoscopic dilatation an average of 1.5 years post-operatively and no patient required reoperation. Patients reported preserved improved quality of life up to 11 years following the operation (p = 0.001).

Conclusion
These results demonstrate the durability of LHMDor in the definitive management of achalasia offering consistent symptomatic relief and significant improvement to QOL over the decade following surgery, despite some increase in GERD symptoms and antacid use.
560 CORRELATION ANALYSIS OF TYPES AND NUMBER OF GASTROESOPHAGEAL REFLUXES WITH NUTRIENTS CONSUMPTION IN CHILDREN
Authors: Morozov S , Borodina G , Nikityuk D 
Published: September 2020

Abstract

Little is known about association of types and number of gastroesophageal refluxes with nutrients consumption in children. However this may be important for planning further research and from the practical point of view.
The aim of the study was to perform a correlation analysis between the number and type of gastroesophageal refluxes (GER) with nutrients consumption in children and adolescents.

Methods
The data of the examination of 219 children served as the source for the study. The complex examination included the analysis of nutrients consumption (Validated language-specific food frequency questionnaire), esophageal pH-impedance recordings (Ohmega, MMS, the Netherlands) esophagogastroscopy (Olympus Excera II, Olympus, Japan). Spearman rank correlation analysis between types and number of gastroesophageal refluxes and level of nutrients consumption was performed with the use of Statistica 10 software (StatSoft Inc, USA). To analyze the data on actual nutrition of children of different age groups, the obtained direct values of were converted into a percentage deviation from the recommended daily allowance rates.

Results
Significant (P &lt; 0.05) inverse correlation was found between AET and consumption of PUFAs (Spearman rank R = -0.33), ω-3 PUFA (R = -0.33), ω-6 PUFA (R = -0.3), vitamin A (R = -0.34), niacin (R = -0.28) and ascorbic acid (R = -0.37).
The number of acid refluxes, was associated with energy values of the rations (R = 0.269), amount of protein (R = 0.279), total fat (R = 0.272), total carbohydrates (R = 0.152), and added sugar (R = 0.157) consumption.
There was no correlation between number of weak-acid refluxes and diet.
Nr of non-acid refluxes was associated with the amount of PUFAs (R = 0.19), ω-6 (R = 0.151), ω-3 (R = 0.19), sodium (R = 0.158), phosphorus (R = 0.166), vitamin B1 (R = 0.17), niacin (R = 0.19), and ascorbic acid (0.23) consumed.

Conclusion
We found that esophageal acid exposure time and number of different types of refluxes (but not weak-acid) may be associated with the consumption of some of the nutrients in children. This information may be of use for the diet correction as a component of treatment of children with GERD.
573 PER-ORAL ENDOSCOPIC MYOTOMY FOR RECURRENT KILLIAN-JAMESON DIVERTICULUM
Authors: Boucher Z , Ducoin C , Velanovich V 
Published: September 2020

Abstract

Killian-Jameson Diverticulum (KGD) is similar to Zenker's diverticulum(ZD) in respect to underlying pathology of protrusion of esophageal mucosa and vague foregut symptoms including dysphagia. However, KGD is distinctly different from ZD due to location of diverticulum, incidence, and preferred surgical approach.

Methods
We present a case of a patient who had previously undergone a transcervical diverticulectomy for JKD. He initially had symptomatic relief but eight months later developed a recurrence of his diverticulum with dysphagia. A per-oral endoscopic myotomy (POEM) was then performed. A video of this endoscopic intervention can be seen in this submission, along with appropriate commentary.

Results
The patient had resolution of his dysphagia and he recovered without complication.

Conclusion
This novel approach to recurrent Killian-Jameson Diverticulum after the more standard open transcervical approach should be considered for this challenging clinical scenario. The basic principles of an endoscopic myotomy can be applied similarly to such a diverticulum.

Video
https://www.dropbox.com/s/dlne8d08tp3rskb/KJ%20Diverticula%203%20min%20Edit%20%28edited%20-%20WeVideo%29.mp4?dl=0
576 P40, P63-NEGATIVE NON-SQUAMOUS CELL CARCINOMA OF ESOPHAGUS EXCEPT FOR ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION, REPORT OF TWO CASES
Authors: Fujishima F , Taniyama Y , Yamauchi T , Akaishi R , Kamei T , Sasano H 
Published: September 2020

Abstract

Esophageal cancer is the eighth most common human malignancy and the sixth most common cause of death from cancer worldwide. In Europe and the United States, the proportion of adenocarcinoma has increased due to the increase of Barrett's adenocarcinoma. On the other hands, in Japan most cases are squamous cell carcinoma and adenocarcinoma except esophagogstric junction including Barrett's adenocarcinoma is extremely rare.

Methods
We experienced two cases of tumors with morphologically no distinct squamous or glandular differentiation and confirmed not to be Barrett’s adenocarcinoma. No clear positive findings for p40 and p63 by immunohistochemistry.
Case 1 is 69-year-old man. Esophagectomy was performed after neoadjuvant chemotherapy. Macroscopic findings of the resected specimen showed 59 × 43 mm of tumor (type 2) at upper to middle thoracic esophagus.
Case 2 is 53-year-old man. Esophagectomy was performed without neoadjuvant chemotherapy. Macroscopic findings of the resected specimen showed 68 × 46 mm of tumor (type 1) at middle thoracic esophagus.

Results
Pathological examination revealed that the cancer cells showed mainly solid proliferation and no clear keratinization and gland formation was observed. The relationship with the duct of esophageal gland proper was not observed.
Immunohistochemistry, tumor cells showed no neuroendocrine differentiation(ChromograninA-, synaptophysin-)and negative for p40, p63 and CK14, on the other hands tumor cells were positive for CK18.

Conclusion
By the WHO classification, in addition to adenocarcinoma of the esophagogastric junction, squamous cell carcinoma, neuroendocrine tumor, and salivary gland type tumor, there is an item of undifferentiated carcinoma. However, tumor cells of our cases had not such strong atypia, and immunohistochemical study showed glandular differentiation. Although we could not clarify the origin of tumor, it was suggested that there may be carcinoma other than adenocarcinoma of the esophagogastric junction, which may have glandular elements.
584 MULTIPLE OBSERVER DETERMINATION OF GASTRO-ESOPHAGEAL JUNCTION CHARACTERISTICS ON VIDEO-FLUOROSCOPY RELATING TO TROUBLESOME DYSPHAGIA POST-FUNDOPLICATION
Authors: Gan S , Lee N , Tan S , Edwards S , Kiroff G , Myers J 
Published: September 2020

Abstract

Dysphagia is a common adverse effect of fundoplication and in some patients, there is no clear identifiable cause despite extensive investigation. Subtle anatomical features of anti-reflux surgery may relate to dysphagia. In this study multiple observers examine gastro-esophageal junction (GEJ) anatomy using objective measures of video-fluoroscopy swallow study (VFSS) to explore possible correlates with post-fundoplication dysphagia.

Methods
Thirty-one patients underwent structured VFSS 6–12 months after laparoscopic total (TotLF) or partial anterior (PAntLF) fundoplication recording: standing AP, 2x standing oblique (SOb), 2x prone oblique (POb), and prone oblique with continuous drinking (PObCont). Post-operative dysphagia was evaluated (Dakkak & Bennett Score: range 0–45; troublesome ≥12). Three observers (Obs1–3) independently measured: GEJ displacement anteriorly; degree of axis deviation of esophagus & GEJ (E-GEJ); posterior distal esophageal angle (PDEA); and GEJ opening diameter cf. maximal distal esophageal diameter (ME-GEJ). Correlations between measurements and dysphagia by operation type were assessed using linear regression analysis and linear mixed-effects models.

Results
Post-operatively, 5/18 TotLF and 4/13 PAntLF patients reported troublesome dysphagia. Three observers independently found: patients with troublesome dysphagia after TotLF had greater anterior displacement of the GEJ (SOb, range 0.61 cm–1.18 cm, Obs1 p = 0.04), and larger axis deviation of E-GEJ (POb, range 3.28°-13.07°, Obs2 p = 0.03) compared to patients with no/mild dysphagia. There was a trend for greater PDEA in patients with troublesome dysphagia after TotLF (POb, range 0.46°-2.12° and PObCont, range 3.37°-13.4°), but this trend did not reach statistical significance. Following PAntLF, all observers recorded a reduction in ME-GEJ for each unit of worsening dysphagia (PObCont, range 0.03 cm–0.04 cm, Obs1 p = 0.02, Obs2 p = 0.02).

Conclusion
Multiple observers concur that anterior GEJ displacement, the angle between the esophagus axis—GEJ axis, and posterior distal esophageal angulation are anatomical factors associated with troublesome dysphagia after total fundoplication. After partial anterior fundoplication, a small reduction in GEJ opening diameter relative to the distal esophagus related to worsening dysphagia. To reduce post-fundoplication dysphagia, attention to operative techniques affecting angulation and luminal diameter at the GEJ by fundoplication and hiatal repair is warranted.
588 THE INFLUENCE OF CHANGE OF DIET COMPOSITION ON ESOPHAGEAL MOTILITY PATTERNS IN PATIENTS WITH NON-EROSIVE GERD
Authors: Morozov S , Isakov V 
Published: September 2020

Abstract

The aim of the study was to evaluate the influence of change in diet composition on high-resolution esophageal manometry (HRM) patterns.

Methods
The data of 43 NERD patients with low (&lt;20 g/day) dietary fibre intake served as a source data. These patients were examined with the use of standard food frequency questionnaire and HRM. Thirty of them received psyllium 5.0 G TID 10 days additionally to their usual diet (NCT01882088). Control group was formed by the database search for patients who had repeated HRM examinations and dietary assessments at the same time point and if no significant change in diet composition was revealed. HRM assessment was in accordance to Chicago-3.0. Non-parametric statistics were used to assess the change in HRM metrics.

Results
Minimal LES resting pressure at rest and after 10 water swallows increased in study group: 5.41 ± 10.1 vs 11.3 ± 9.4 mmHg, P = 0.023 and 14.1 ± 8.0 vs 14.9 ± 6.4 mmHg, P = 0.008. No difference was found in those whose diet composition was stable. Ineffective esophageal motility initially was found in 46.7% patients of the study group and 53.8% in the control group (P = 0.7). IEM resolved in 71.4% of the study group, and in 14.3% of controls (P = 0.0135). IEM not changed in 28.6% of the study group and in 85.7% of controls, P = 0.014. New IEM revealed in 12.5% of the study group and 16.7% among the controls (P = 0.13).

Conclusion
Change of diet composition by additional quantity of dietary fibre (psyllium) to the standard rations may result in the improvement of esophageal motility.