bluuebunny/crossref_metadata_2025_split huggingface dataset:
O129 CLASSIFICATION OF BARRETT’S CARCINOMA SPECIMENS BY HYPERSPECTRAL IMAGING (HSI)
Authors: René Thieme , Marianne Maktabi , Hannes Köhler , Claire Chalopin , Boris Jansen-Winkeln , Ines Gockel 
Published: November 2019

Abstract

Aim
Hyperspectral imaging (HSI) technology combines imaging with spectroscopy and can be used for the classification of malignant and non-malignant cells. Thereby HSI combined with artificial intelligent algorithms can be used to predict tumor cells in in Barrett’s carcinoma specimens.

Methods
HSI imaging records light between the visual and near-infrared light (500-1000nm). For a first feasibility study, this technique was used to discriminate between squamous epithelium and esophageal adenocarcinoma and 45 specimens from Barrett’s carcinoma patients were recorded. In 22 of the 45 investigated specimens contained also squamous epithelium. The specimens were fixed routinely after resection in paraformaldehyde, were sliced to 3μm, and were stained by haematoxylin and eosin (HE). A non-parametric supervised classification learning algorithm (K-nearest neighbours (k-NN)) was used for discrimination.

Results
Barrett’s adenocarcinoma cells were recorded by HSI in all 45 investigated cases. Squamous epithelium and Barrett’s adenocarcinoma cells displayed differences in the absorbance between the wave lengths of 500 to 700 nm. For both, the squamous epithelium and the Barrett’s adenocarcinoma cells, the intra group variances of the investigated specimens were quite low. 333,275 and 74,000 spectra could be measured from Barrett’s adenocarcinoma and from squamous epithelium, respectively. Specificity, sensitivity and precision with a k-NN (k=5) classifier were 0.74, 0.92 and 0.94 for the presence of Barrett’s adenocarcinoma cells.

Conclusions
HE-stained squamous epithelium and Barrett’s adenocarcinoma cells showed specific spectral alterations, when measured by HSI. These characteristics could be used in the future to develop a computer-assisted algorithm to discriminate semi-automated for tumor cells Barrett’s carcinoma specimens, which will help to foster decision-making support in histopathological diagnosis.
P130 HISTONE DEACETYLASES EXPRESSION AND ACTIVITY IN ESOPHAGEAL ADENOCARCINOMA CELLS IN VITRO
Authors: René Thieme , Robert Nowotny , Ronja Maly , Orestis Lyros , Finn K Hansen , Ines Gockel 
Published: November 2019

Abstract

Aim
The response of EAC patients to common chemotherapeutic regimens is relatively low (approx. 50%). Improving the response rate in cancer patients is challenging and novel therapeutic treatment options are needed. Histone deacetylases (HDAC), an enzyme class with promising novel features, are involved the regulation of gene expression affecting the epigenom.

Methods
The expression of Zn2+-dependent HDACs and the endogenous HDAC activity were characterized in a Berrett’s esophagus in vitro model, containing cells from squamous epithelium, Barrett’s metaplasia, dysplasia and EAC. Proliferation assays were carried out in EAC cells to determine cell response to an experimental, HDAC1-3 specific, HDAC inhibitor (HDACi) in comparison to vorinostat (pan HDACi). The HDAC activity, the p21 expression, and the histone H3 acetylation were investigated under HDACi treatment.

Results
All Zn2+-dependent HDACs were expressed by each stage of the Berrett’s esophagus in vitro model. However, the expression intensity was variable. Vorinostat showed an inhibition of proliferation in the EAC cells OE33 and OE19 (IC50 of 1.1μM and 1.8μM), while the experimental HDACi DDK137 revealed an increased anti proliferative effect (IC50 of 0.4μM and 0.6μM), a higher HDAC activity reduction, and higher increase in H3 acetylation. The p21 mRNA-expression showed a cell line, time and inhibitor specific increase. The highest increase was determined in OE33 cells (2.5fold) by DDK137 after 48h, while no increase in p21 was measured under vorinostat treatment.

Conclusion
We could show a pharmacological more potent HDACi than vorinostat in EAC cells in vitro. However, further studies are necessary to evaluate the significance of HDACi and whether HDACi are able to increase chemosensitivity in EAC patients.
P132 LARYNGOPHARYNGEAL PH MONITORING (RESTECH) MAY PREDICT A SUCCESSFUL SURGICAL OUTCOME FOR REGURGITATION AND OROPHARYNGEAL SYMPTOMS AFTER LAPAROSCOPIC ANTIREFLUX SURGERY
Authors: Müller D T , Knepper L , Schröder W , Bruns C J , Leers J M , Fuchs H F 
Published: November 2019

Abstract

Introduction/Aim
Laryngopharyngeal pH-monitoring (Restech) is a relatively new reflux testing device that needs more validation. It was developed to detect both liquid and acidic gas vapor, and the more consistent pharyngeal placement may lead to more reliable results, especially when laryngopharyngeal symptoms such as cough, hoarseness and globus sensation are present. Aim of this study is to determine if Restech can identify patients with a successful outcome for certain symptoms after antireflux surgery.

Background and Methods
In our esophageal center of excellence, more than 300 esophageal surgeries are performed annually. All patients are prospectively entered in our IRB approved database and undergo a routine check-up program with postoperative surveillance following surgery. All patients with suspicion for GERD received a complete diagnostic work-up for gastroesophageal reflux including symptom evaluation, endoscopy, 24-hour impedance pH-metry, high resolution manometry and Restech. Only patients with a complete dataset and oropharyngeal reflux symptoms were included in this study.

Results
A total of 155 [99 females] consecutive patients with suspected gastroesophageal reflux disease and oropharyngeal symptoms that were seen between 10/2013 and 08/2018 were included and underwent 24-h laryngopharyngeal with concomitant esophageal pH-monitoring.
A total of 24 of these patients with laryngopharyngeal symptoms underwent laparoscopic antireflux surgery from 10/2013 - 02/2018 and had a complete follow up. Restech evaluation was abnormal in 62.5% (n=15, mean RYAN Score upright 121.73 [35.1-386.05], mean RYAN Score supine 5.74 [2.17-50.62]). Two out of preoperatively 12 [16.7%] patients with a pathologic Restech test complained about regurgitation after surgery versus 4 out of preoperatively 8 [50%] patients with a normal Restech result. No patient with an abnormal Restech result out of preoperatively 11 complained about extraesophageal symptoms after the surgery versus 1 from preoperatively 4 [25%] patients with a negative Restech.

Conclusion
An abnormal Restech result better identifies a successful outcome for regurgitation and extraesophageal symptoms after antireflux surgery. All patients had a complete resolution of extraesophageal symptoms after surgery.
P133 INTRATORATHIC ANASTOMOSIS IN IVOR-LEWIS ESOFAGUECTOMY: TECHNICAL DESCRIPTION AND RESULTS
Authors: Menéndez M , Mingol F , Bruna M , Vaqué F J , Alvarez E , Hurtado L , Pérez C , García-Granero E 
Published: November 2019

Abstract

Aim
Description of the technique of intrathoracic anastomosis in Ivor-Lewis esophagectomy in prone position with minimally invasive approach (MIE) by manual tobacco-bag suture and anastomosis with circular stapler and its results.

Background & Methods
Retrospective descriptive analysis of the intrathoracic anastomosis technique in prone of the cases performed in our Health Care Center by thoracoscopic and laparoscopic approach in Ivor-Lewis esophagectomy between April 2017 and December 2018. Patients who required conversion to thoracotomy due to pleural adhesions were excluded

Results
The median age of the 18 patients was 59 years (54-67 years). In the 18 analyzed (17 adenocarcinomas of 1/3 lower or gastro-esophageal junction and 1 benign stenosis post-RT) 12 were performed with mechanical anastomosis CEA 25, 2 with CEA 28 and 4 with Orvyl CEA 25. No leakage occurred during the postoperative period, performing in 16 a TEGD at 4-5º DPO. Three patients underwent feeding jejunostomy. In the postoperative period, 2 patients presented with ARDS, 2 with pneumonia, 2 with pleural effusion, and 1 with AF. In the follow-up performed until May 2019 1 patient presented stenosis of the anastomosis that was treated by endoscopic dilation. No leakage of the anastomosis has been recorded. The postoperative mortality (<30 days) was 0%

Conclusion
Compared with other technical variations, even with another type of anastomosis, the circular mechanical anastomosis, making the tobacco bag around the head by manual suture and reinforcing it by Endoloop is a safe and reproducible technique with a 0% leakage rate and stenosis of 5.88%. According to the literature, the rate of anastomotic leakage in the thoracoscopic approach is between 0-20% and that of anastomotic stenosis is 0-27.5%, without finding significant differences between the different types of anastomosis.
It has been demonstrated in numerous series that the thoracoscopic approach is oncologically equal to or better than the approach by thoracotomy because it allows a better dissection with resection of a greater number of nodes and that provides benefits such as less postoperative pain, better patient ventilation, better ergonomics for the surgeon and better vision of the operative field. However, we believe that this new approach should not change the usual technique of performing the anastomosis or the indication of the Ivor-Lewis esophagectomy. Randomized studies with a larger number of cases are necessary to determine which anastomosis technique is safest and reproducible in MIE surgery of esophageal cancer.
P14 THE IMPACT OF TRANSTHORACIC AND TRANSHIATAL ESOPHAGECTOMY ON LONG-TERM QUALITY OF LIFE ACCORDING TO EORTC QLQ-C30 AND EORTC QLQ-OG25 QUESTIONNAIRES
Authors: Jezerskyte E , Saadeh L M , Hagens E R C , Sprangers M A G , Noteboom L , van Laarhoven H W M , Eshuis W J , van Berge Henegouwen M I , Gisbertz S S 
Published: November 2019

Abstract

Aim
The aim of this study was to evaluate long-term HR-QoL in patients undergoing transhiatal versus transthoracic esophagectomy in a tertiary referral center.

Background & Methods
Treatment of esophageal cancers is challenging. Besides (neo)adjuvant chemo(radio)therapy different surgical approaches are possible such as transhiatal (THE) or transthoracic esophagectomy (TTE) with a cervical or intrathoracic anastomosis. Studies have been performed to establish evidence which is the preferred procedure in terms of postoperative morbidity, survival and short- and long-term health-related quality of life (HR-QoL).
All patients after THE or TTE for distal esophageal or gastroesophageal junction carcinoma performed between 2003 and 2016 received EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. All questionnaires with a follow-up of more than two years after surgery were analysed. Three HR-QoL domains were chosen as primary endpoints: problems with eating, reflux and nausea and vomiting. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. The results were corrected for possible confounders such as age and gender.

Results
The questionnaire response rate was 47.6%, with 56 patients in the THE group and 134 in the TTE group. The mean age was 63.5 years and a median follow-up of 3.7 years (range 24-137 months) was reached. No significant difference was found in any of the HR-QoL domains or postoperative complications between the two groups. Significantly more lymph nodes were resected in the TTE group (p<0.001). No difference was found in the lymph node metastases or radicality of surgery between the two groups.

Conclusion
After a long follow-up of more than two years no differences in HR-QoL or postoperative complications were found between patients with distal esophageal or gastroesophageal junction carcinoma undergoing THE or TTE esophagectomy. Based on this study we conclude that long-term quality of life should not influence the decision making for surgical approach between THE and TTE esophagectomy.
P140 LAPAROSCOPIC MODIFIED BELSEY TYPE FUNDOPLICATION FOR REFLUX AFTER ROUX Y GASTRIC BYPASS – A POTENTIAL SAVIOR WHEN THE SAVIOR IS IN TROUBLE!
Authors: Hatem Al Saadi , Syed Raza , Alistair Sharples , Vittal Rao , Balaji Nagammapudur 
Published: November 2019

Abstract

Background
Roux Y Gastric Bypass (RYGB) is the preferred primary bariatric surgical option in patients with preoperative gastro oesophageal reflux disease (GERD). It is also the preferred revisional bariatric surgery after when GERD develops after an alternate primary bariatric surgery. However reflux after RYGB although uncommon can present due to a variety of factors. Management can be challenging.

Aim/Hypothesis
A modified version of the Belsey IV fundoplication can be done laparoscopically to reconstitute the antireflux barrier in the absence of a Fundal remnant in the gastric pouch after RYGB.

Methods
We present a single patient experience/case study where there was evidence of recurrent GERD in spite of a successful RYGB in terms of weight loss and comorbidity resolution. A 42 year old female with a BMI > 40 and metabolic co-morbidities and GERD was deemed fit for RYGB. After a technically uneventful RYGB with standard limb lengths ( Roux 120cms and BP limb 70 cms) there was significant weight loss ( > 70% EBWL) and co-morbidity resolution. However her symptoms of GERD persisted.
An gastroscopy confimed esophagitis and a barium swallow showed evidence of GERD with a small hiatal hernia and a 3-4 cms Candy cane limb. There was no evidence of a gastrogastric fistula.
Revisonal surgery was done which revealed no significant candy cane limb. A small (<2cms) hiatal hernia was found. Complete esophageal mobilization and a hiatal hernia repair was done in a standard fashion.
Furthermore the anterior wall of the long gastric pouch was invaginated to obtain an approximate coverage of 200 degrees in a single layer Belsey technique. The procedure was completed laparoscopically.

Results
The post-operative period was uneventful. Patient reported complete absence of reflux after surgery and remains off PPI in the short term. Temporary dysphagia was noticed in the first few weeks after surgery which improved with expectant treatment.

Conclusion
A Laparoscopic modified Belsey type fundoplication serves as an effective method to treat GERD after a RYGB if other potential causes of GERD are excluded.
P146 AN IMPROVEMENT TO THE CIRCULAR STAPLING ANASTOMOSIS TECHNIQUE DURING MINIMALLY
Authors: Giovanni Capovilla , Elisa Sefora Pierobon , Lucia Moletta , Luca Provenzano , Mario Costantini , Renato Salvador , Stefano Merigliano , Michele Valmasoni 
Published: November 2019

Abstract

Aim
The circular stapled (CS) technique with transoral placement of the anvil is commonly used to perform the esophago-gastric anastomosis during minimally invasive esophagectomy (MIE). The procedure is safe, efficient and highly reproducible, however the intersection between the circular plane of the stapler and the linear staple line of the esophageal stump can expose the anastomosis to the formation of dog ears and therefore increase the risk of anastomotic leakage (AL). We describe a simple modification of the CS technique that avoid the formation of staple lines intersection.

Background and Methods
We prospectively collected data on a small group of patients who underwent MIE for cancer using our modified CS technique. Our technical modification consists in folding the linear esophageal transection line with a stitch around the anvil shaft, in order to include the staple line in the resection during the EEATM firing (figure 1).
Feasibility has been evaluated as the percentage of cases in which the improved anastomosis technique has been carried out successfully with the formation of a complete anastomotic ring. Safety has been defined as the absence of procedure related complications.

Results
MIE was performed in ten patients using our modified CS technique, median age was 55 years. All the procedures were successfully completed with complete resection of the linear esophageal staple line and no intraoperative complication. Only one patient developed a postoperative AL, that was only detected by barium swallow and did not cause any symptom or clinical sign.

Conclusions
Our modified CS technique is simple, feasible and safe. Further studies are needed to evaluate its efficacy in preventing the occurrence of anastomosis leakage.
P147 IS HYBRID MINIMALLY INVASIVE ESOPHAGECTOMY SAFE FOR SIEWERT TYPE II OESOGASTRIC JUNCTION TUMORS?
Authors: Simon Gabriel , Alexandre Challine , Marguerite Messier , Clarisse Eveno , Maxime Warlaumont , Guillaume Piessen 
Published: November 2019

Abstract

Background
In the MIRO trial, hybrid minimally invasive Ivor Lewis (IL) resulted in a lower incidence of intraoperative and postoperative major complications, specifically pulmonary complications, than open IL without compromising oncological resection criteria and 3 years survival results. However, only infracarenal and Siewert I oesogastric junction (OGJ) tumors were included. Whether hybrid approach for Siewert II OGJ tumours remains unknown with a potential risk of tumor spillage. The aim of this study was to compare hybrid and open IL for patients with Siewert II OGJ tumours.

Materials and Methods
Data from 83 patients who underwent surgery for Siewert II OGJ tumours in our institution were collected prospectively between 2011 and 2017. Overall, 53 patients were included in the hybrid group and 30 in the open group. The main outcome was radicality of resection (R0 / R1 margins and number of lymph nodes resected). Groups were compared in univariate and multivariate analysis with a propensity score-adjustment.

Results
After adjustment, the hybrid and open groups were comparable in terms of number of lymph nodes resection: OR=0.65 (0.25-1.66) and radicality of resection; (R0/R1): OR=0.93 (0.10-8.58) with similar long term overall (OS) and disease-free (DFS) survival (5-year OS: 68% vs. 58%, p=0.463; 5-year DFS: 56% vs. 42%, p=0. 323). There were significantly fewer pulmonary complications in the hybrid group: OR=0.38 (.14-0.95).

Conclusion
Hybrid IL for Siewert II OGJ tumors do not compromise oncological quality resection and long term OS and DFS and results in a lower incidence of pulmonary complications than open IL.
O148 SHORT-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIATION FOR CANCER
Authors: Nilsson K , Klevebro F ,   I,   M, Szabo E , Halldestam I , Johnsson E , Wallner B , Johansson J , Johnsen G , Aahlin E K , Hjortland G O , Bruns C , Schröder W , Nilsson M 
Published: November 2019

Abstract

Aim
The aim of this study was to clarify if prolonged time to surgery (TTS) improves postoperative outcomes in the curative intended treatment of an junctional cancer.

Background & Methods
sophagectomy is conventionally performed 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, studies have shown that prolonged TTS might be favourable.
A randomized multicentre clinical trial was performed with allocation to 4-6 or 10-12 weeks between finished nCRT and surgery. All patients received nCRT according to CROSS. Primary outcome of thstudy was postoperative. Smortality, need for intensive care, and length of hospital stay.

Results
The study randomized 248 patients, 202have to date undergone esophagectomy 98 patients were allocated to prolonged TTS, and the groups were well matched concerning baseline characteristics. Postoperative complications were reported in 106 patients (52.5%).There was no difference in postoperative Clavien-Dindo score.In the standardgroup 17 (16.4%) patients had anastomotic leak compared to 19 (19.4%) in the prolongedgroup (P=0.572). Conduit necrosis was reported in 9 (4.5%) patients, esophago-bronchial fistula in 1 (0.5%) patient,chyle leak in 5 (2.5%) neumoni in 54 (26.7%) patients and respiratory insufficiency in 36 (17.8%) patients without significant difference . In the standard group 5 (4.8%) patients had postoperative mortality due to a complication, compared to 2 (2.0%) patients in the prolonged group (P=0.446). Median length of hospital stay was 14 days in the standard group and 17.5 days in the prolonged group (P=0.040).

Conclusion
In this we found no significant differences in postoperative mortality comparing standard to prolonged TTS after nCRT. Although, an observandum is that the median length of hospital stay was significantly longer in the prolonged group. We need to compare response and survival to properly evaluate prolonged TTS, but these results suggest that timing is not cardinal in short-term postoperative outcomes.
P150 ULCERATING CMV ESOPHAGITIS – A UNIQUE COMPLICATION OF ACHALASIA
Authors: Corvinus F , Neumann H , Babic B , Kovalets I , Grimminger P 
Published: November 2019

Abstract

Aim
Ulcerating CMV associated esophagitis in an immuncompetent patient has not been described before. This case report highlights diagnostic pitfalls in differentiating achalasia from pseudo achalasia.

Background & Methods
A 41-year-old man presented to the high resolution manometry lab with progressive retrosternal dysphagia and regurgitation. Endoscopy revealed a dilated esophagus with a passable stenosis of the esophagogastric junction. Between 27 to 39 cm a deep 3 x 12 cm ulcer reaching the lamina muscularis was detected. Biopsies were taken and processed to the institute for pathology and microbiology.
A barium swallow revealed typical features of achalasia. A dilated hypomotile esophagus and a beak sign were seen.
Histopathology described a deep ulcer with a mixed inflammatory infiltration without any signs for malignancy. The virology finally revealed a strong positivity for CMV in PCR. Therefor the diagnosis of CMV esophagitis was made. Reasons for an immunodeficiency (HIV, Trypanosoma pallidum etc.) could be excluded. After endoscopic placement of a probe, high resolution manometry was performed. It showed a disturbed EGJ relaxation, an enhanced residual pressure (IRP) and panesophageal pressurizations in almost every swallow. These are typical features of Type II Achalasia (Chicago Classification v 3.0).

Results
The patient received antiviral therapy (Ganciclovir) for 2 months. Only a moderate symptom relief was achieved. Endoscopic reevaluation showed a complete remission of the huge esophageal ulcer. There was no esophageal scar or other reason for EGJ obstruction. CMV was no longer detected. A second high resolution manometry confirmed again a Type II Achalasia. The patient underwent laparoscopic myotomy an 180° degree fundoplication. 6 months after the intervention the patient is well and has a complete remission of his symptoms.

Conclusion
Although ulcerating CMV esophagitis may be a cause of pseudoachalasia, in this case for the first time primary achalasia is described to be the reason for ulcerating CMV esophagitis.