bluuebunny/crossref_metadata_2025_split huggingface dataset:
173 CATERPILLAR SIGN: NOVEL ENDOSCOPIC FINDING IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Authors: Ayaki Maki , Manabe Noriaki , Haruma Ken , Nakamura Jun , Fujita Minoru , Suehiro Mitsuhiko , Kawamoto Hirofumi , Kamada Tomoari , Yamatsuji Tomoki , Naomoto Yoshio 
Published: September 2021

Abstract

Pathological identification of esophageal eosinophilia (EE) is considered to be most important and critical step for diagnosis of eosinophilic esophagitis (EoE). Although several endoscopic findings related with EoE have been reported, it is still difficult to exclude other causes of EE, such as gastroesophageal reflux disease. Here, we noted a novel endoscopic finding related with EoE termed ‘Caterpillar sign’. The aim of this study was to evaluate its clinical significance for the diagnosis of EoE.

Methods
One hundred and seventy-four patients who were endoscopically suspected with EoE at our hospital and affiliated institutions were enrolled. EoE was defined clinically by symptoms of esophageal dysfunction and histologically by the presence of EE [≧15 eosinophils/high power field (HPF)]. Endoscopic findings at baseline were retrospectively reviewed. ‘Caterpillar sign’ was defined as a stair-like, fragile, slight mucosal protruded lesion sandwiched between longitudinal furrows, such as the Caterpillar traces remaining on the ground (Figure). Furthermore, the clinicopathological features of patients having ‘Caterpillar sign’ were evaluated.

Results
One hundred and seventy-four patients (92 males, 82 females with mean age of 49.7) suspected with EoE were evaluated, of whom 60 (34.5%) was finally diagnosed as EoE. ‘Caterpillar sign’ was found in 48 patients (80.0%). Sensitivity and Specificity of ‘Caterpillar sign’ for the diagnosis of EoE was 0.80 (95% confidence interval [CI] 0.72–0.85) and 0.94 (95% CI 0.90–0.97), respectively. Furthermore, the presence of ‘Caterpillar sign’ was associated with degree of eosinophil infiltration (Caterpillar sign positive: 42.9 ± 49.3/HPF vs. Caterpillar sign negative: 6.7 ± 24.4/HPF, p &lt; 0.0001).

Conclusion
This novel finding termed ‘Caterpillar sign’ was clinically useful for the definitive diagnosis of EoE and associated with degree of eosinophil infiltration.
185 THE EFFECT OF PSYCHOLOGICAL PREPARATION ON THE LEVEL OF ANXIETY BEFORE UPPER GASTROINTESTINAL ENDOSCOPY
Authors: Javaherforoushzadeh Ali , Behrouzian Forouzan , Sadrizadeh Neda , Nematpour Sorour , Seyedian Seyed Saeed , Nassiryan Maryam 
Published: September 2021

Abstract

Anxiety is one of the problems in patients undergoing invasive procedures. One way to control anxiety is through psychological preparation. This study was aimed to evaluate the effect of psychological preparation on anxiety level in patients undergoing upper gastrointestinal endoscopy.

Methods
The present study consisted of 98 patients which were referred to Ahvaz Golestan Hospital for upper gastrointestinal endoscopy. They were randomly (table of random numbers) divided into a control group and an experimental group. All of the participants filled out Spielberg State–Trait Anxiety Inventory (STAI). The experimental group was psychologically prepared for endoscopy (given information about endoscopy and behavioural intervention), and then both groups were asked to complete STAI again an hour before endoscopy. The collected data were analysed through Mann–Whitney, Kruskal-Wallis, and Chi-square tests using SPSS 17.0.

Results
Before the intervention was carried out, there was no significant difference between the two groups in terms of the rate of state and trait anxiety (p &gt; 0.05). After the intervention, the rate of state and trait anxiety decreased significantly (p &lt; 0.05) in experimental group.

Conclusion
In patients subjected to endoscopy, psychological preparation was effective in reducing their anxiety and thus this can be considered as an efficient method in decreasing anxiety.
190 THE USEFULNESS OF A BILATERAL TRANS-CERVICAL PNEUMOMEDIASTINAL APPROACH FOR MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY
Authors: Tokairin Yutaka , Nakajima Yasuaki , Kawada Kenro , Hoshino Akihiro , Okada Takuya , Matsui Toshihiro , Yamaguchi Kazuya , Nagai Kagami , Kinugasa Yusuke 
Published: September 2021

Abstract

Several authors have reported on the left trans-cervical and transhiatal approaches under pneumomediastinum and right cervical open surgery for mediastinoscopic esophagectomy. However, with these approaches, sufficient dissection of the right upper mediastinal paraesophageal lymph nodes, right recurrent nerve lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes is thought to be difficult. We herein report the usefulness of the ‘bilateral’ trans-cervical pneumomediastinal approach.

Methods
Ten patients with thoracic esophageal cancer were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach. After this approach, thoracoscopic observation was then performed in the left decubitus position, and if the lymph nodes were not sufficiently dissected, the remnant lymph nodes were retrieved thoracoscopically.

Results
The average total number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average total number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without the right trans-cervical pneumomediastinal approach, roughly four of the right cervical and upper mediastinal paraesophageal lymph nodes and one or two of the subaortic arch to the left tracheobronchial lymph nodes could not have been retrieved.

Conclusion
A bilateral trans-cervical pneumomediastinal approach is useful for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.
201 POSTOPERATIVE OUTCOMES OF MINIMALLY INVASIVE ESOPHAGEAL SURGERY FOR ESOPHAGEAL CANCER IN A SINGLE CENTER
Authors: Yi Eunjue , Lee Jun Hee , Jung Younggi , Lee Kwanghyong , Lee Sungho 
Published: September 2021

Abstract

The aim if this study is to evaluate the safety and feasibility of minimally invasive esophageal surgery for esophageal cancer in a small volume center.

Methods
The medical records of patients who had undergone minimally invasive esophageal surgery (VATS Ivor Lewis operation with laparoscopic gastric mobilization) for their esophageal cancer between June 2017 and September 2019 in our institute were reviewed retrospectively. Perioperative outcomes including postoperative morbidities and mortalities were evaluated.

Results
A total of 31 patients were included in this study. The mean operation time for laparoscopic gastric mobilization were 111.3 minutes and those for VATS Ivor Lewis operation were 235.5 minutes. Seven patients underwent Neoadjuvant therapy. Half of the cases were stage I, however, operation could be performed in more advanced cases. There was no conversion to open procedure.
Overall complication rates were 49.1%, and complication more than Grade III in Clavien-Dindo classification were 16.1%. Overall postoperative morality was 6.4%. Two patients died at 42 and 47 postoperative days due to acute respiratory failure, and one patient.

Conclusion
Minimally invasive esophageal surgery for esophageal cancer could be feasibly performed even in advanced cases. Postoperative pneumonia should be carefully managed to prevent postoperative mortality.
213 CLINICAL SIGNIFICANCE OF ROBOTIC ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER
Authors: Takeuchi Hiroya , Kikuchi Hirotoshi , Hiramatsu Yoshihiro , Matsumoto Tomohiro , Soneda Wataru , Kamiya Kinji 
Published: September 2021

Abstract

Nowadays many patients with esophageal cancer are treated with thoracoscopic esophagectomy (TE) with precise mediastinal lymphadenectomy as a minimally invasive esophagectomy (MIE) in Japan. These advanced endoscopic surgeries are believed to contribute to early postoperative recovery. More recently robotic esophagectomy (RE) appeared attractively. To date, however, there has been a very limited number of comparison studies to verify the benefits of RE for esophageal cancer, especially in Japan where squamous cell carcinoma is predominant.

Methods
We retrospectively compared the short-term outcomes between TE (n = 43) and RE (n = 19) which were performed in our institution between 2018 and 2020 to verify the clinical significance of RE. Preoperative background factors of the patients compared were almost identical between the two groups.

Results
The operative time was longer in the RE group than in the OE group, whereas blood loss was equivalent between the two groups. There was no significant differences in the number of dissected mediastinal lymph nodes between the TE and RE groups (33+/−15 vs 29+/−11).
The incidence of postoperative recurrent laryngeal nerve palsy was markedly less in the RE group than the TE group (5.2% vs. 18.6%). Moreover, the incidence of postoperative pneumonia also tended to be less in the RE group than in the TE group (5.2% vs. 11.6%). There were no operative mortality in the two groups.

Conclusion
Our results suggest that RE is comparable with conventional TE in terms of short-term outcome after surgery, and beneficial to technically reduce the recurrent laryngeal nerve palsy as a promising MIE.
235 5-YEAR FOLLOW-UP OF A PROSPECTIVE CLINICAL TRIAL OF AN ENDOSCOPIC FULL-THICKNESS PLICATION DEVICE (GERDX™) FOR THE TREATMENT OF GERD
Authors: Tschoner Andreas , Punkenhofer Paul , Spaun Georg , Koch Oliver , Fuegger Reinhold 
Published: September 2021

Abstract

The gold-standard in the operative treatment of gastroesophageal reflux disease (GERD) is the laparoscopic fundoplication. Alternatively, endoscopic devices to rebuild the gastroesophageal valve were invented. The aim of our study is to assess the improvement of GERD symptoms and quality of life in patients five years after the endoscopic full-thickness plication with the GERDx™ device.

Methods
Between 2013 and 2016 a prospective trial was implemented with forty patients and an endoscopic plication due to reflux symptoms with a pathologic workup for GERD. Limitation for the use of GERDx™ was a 2 cm hiatal hernia. Follow-up workup was done with high resolution manometry (HRM), 24 h-pH-impedance-catheter gastroscopy and questionaires for quality of life (GIQLI) and reflux-symptoms (SCL).

Results
Median follow-up time was 57 months (36–74 months). There was a significant improvement of the DeMeester score, GIQLI and SCL between pre- and postoperative values in short-term as well as long-term follow-up. At least 55% of patients were assessed as failure of the plication device due to redo operations with laparoscopic fundoplication in 25% and/or necessary PPI use for GERD symptoms (40%). There is no pre- and postoperative significant difference in quality of life or reflux scores between successful and failed endoplications, but patients with laparoscopic redo operations showed significant higher DeMeester scores before and after endoscopic treatment.

Conclusion
There is a higher failure rate to the endoscopic full-thickness plication than to the laparoscopic fundoplication. A small group of well selected patients is eligible for the endoscopic GERDx™ device. In case of therapeutic failure a classic laparoscopic redo fundoplication is possible under more challenging operative conditions.
238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES
Authors: Labgaa Ismail , Mantziari Styliani , Winiker-Seeberger Michael , Pasquier Jerôme , Messier Marguerite , Elliot Jessie A , Kamiya Satoshi , Kalff Marianne C , Hübner Martin , Allemann Pierre , Henegouwen Mark Van Berge , Nilsen Magnus , Reynolds John , Piessen Guillaume , Demartines Nicolas , Schäfer Markus 
Published: September 2021

Abstract

The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy.

Methods
Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS).

Results
A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009).

Conclusion
Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.
244 MICROBIOME ANALYSIS OF UPPER DIGESTIVE TRACT BIOPSY SAMPLES FROM INDIVIDUALS ALONG THE METAPLASIA-DYSPLASIA-ADENOCARCINOMA SEQUENCE.
Authors: Elliott Jessie , Elliott Jessie , Hand Collette , Shanahan Fergus , Murphy Thomas , O'Toole Paul 
Published: September 2021

Abstract

The human microbiota, the collection of microbes that inhabit the human body, is increasingly being appreciated as playing a role in human health. A seminal example of this relationship is Helicobacter pylori and gastric cancer oncogenesis. The drop in H.pylori infections and non-cardia gastric cancer incidences has coincided with the rise in oesophageal adenocarcinoma (OAC) incidences. We sought to explore the relationship between the upper digestive tract microbiome and OAC oncogenesis.

Methods
Pinch biopsies were taken from individual’s oesophagus and stomach who were along the metaplasia-dysplasia-adenocarcinoma sequence (GERD, Barrett's oesophagus, dysplasia, OAC, metastatic OAC) as well as healthy controls. We carried out 16 s rRNA gene DNA sequencing protocols on these samples. DNA extraction and library preparation was performed with consideration to the low mass nature of oesophageal biopsies. Raw reads were processed and amplicon sequence variants (ASVs) were generated using the DADA2. We dissected ecological differences between sample site and clinical classification using a variety of approaches including examining differentially abundant taxa and inferred metabolic pathways, alpha diversity and beta-diversity.

Results
The upper digestive tract was found to be dominated by the genera Streptococcus, Prevotella, and Haemophilus. There was no statistically significant shift in beta diversity with respect to biopsy location. Alpha diversity was reduced in gastric biopsies compare to oesophageal biopsies. A slight yet significant shift was seen in beta diversity (Bray–Curtis Dissimilarity) with respect to clinical classification in biopsies derived from the gastroesophageal junction (GEJ) and stomach.
Various taxa were found to be differentially abundant between biopsy site and with regard to clinical classification.

Conclusion
OAC primarily occurs at the GEJ. Community structure was shifted in samples derived from the GEJ and the stomach. Fusobacterium nucleatum was overrepresented in oesophageal biopsies from individuals with diseased oesophagus compared to individuals with a histologically normal oesophagus. This bacterium has been implicated in oncogenesis of various cancers most notably colorectal cancer. Serval ASVs assigned to the genus Prevotella were depleted in stomachs of individuals with metastatic OAC compared to all other groups.
254 LYMPH NODE DISSECTION IN T1 AND T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MINIMALLY INVASIVE ESOPHAGECTOMY VERSUS OPEN SURGERY
Authors: Teng Xiao , Cao Jinlin , Xu Jinming , He Cheng , Zhang Chong , Ye Peng , Hu Jian 
Published: September 2021

Abstract

Minimally invasive esophagectomy is increasingly performed for esophageal squamous carcinoma, with advantages of improved perioperative outcomes in comparison with open esophagectomy. Lymph node dissection is one of most important prognostic factors, in esophageal squamous cell carcinoma. It is still unknown whether MIE can meet the criteria of lymph node dissection in the mediastinum, especially in T1 and T2 esophageal cancer. Here, we compared the lymph node dissection between MIE and open surgery.

Methods
We retrospectively reviewed the clinicopathological data from 147 patients who underwent open surgery and MIE for esophageal squamous cell carcinoma from December 2016 to January 2020. The clinicopathological data including age, gender, number of lymph node resected were analyzed.

Results
68 patients underwent MIE and 79 patients underwent open surgery. The number of harvested lymph node didn’t differ between the open surgery group and MIE group (26 ± 11.9 vs 26 ± 13.4, respectively, p = 0.128). However, the number of resected lymph node in the low para-esophageal region was significantly higher in open surgery group (4.1 ± 3.9 vs 2.8 ± 2.6, respectively, p = 0.019). The number of resected lymph node in the upper mediastinal region was significantly higher in the MIE group in T1 and T2 patients (4.7 ± 3.8 vs 2.7 ± 2.9, respectively, p = 0.014). the difference was also noticed in the para-recurrent laryngeal lymph node regions (3.6 ± 2.9 vs 2.0 ± 2.3, respectively, p = 0.020).

Conclusion
For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection by MIE was comparable to that by open surgery. However, the number of harvested lymph node in the upper mediastinal region was better in the MIE group, which may indicate a better outcome. There was no difference in the postoperative complications, hospital stay and overall survival rate.
280 CONVERSION SURGERY FOR BORDERLINE T4 ESOPHAGEAL CANCER
Authors: Ogata Takashi 
Published: September 2021

Abstract

Due to development of neo-adjuvant chemotherapy or chemoradiotherapy, the possibility of surgical resection for borderlint T4 esophageal cancer that seems difficult to resect is emerging. We retrospectively examine the effects of conversion surgery in patients for esophageal cancer as part of multidisciplinary treatment.

Methods
We undergo 364 cases esophagectomy between Jan 2011 and Dec 2018, and of the 10 cases were diagnosed as borderline resectable esophageal cancer patients at first admission. These 10 cases were undergone conversion surgery after chemotherapy. We retrospectively examined preoperative and postoperative treatment and their prognosis.

Results
The chemotherapy regimens given above 10 cases were DCF (4cases) and FP (6 cases). Borderline target organs: Aorta (4 cases), Left main bronchus(6 cases), LN invasion to pancreas (1 case). R0 surgery was achieved in 8 of 10 cases, and the pathological response was G1a: 5 cases, G1b: 2 cases, G2: 3 cases. The median number of lymph node metastases is 3 (0–19), with recurrence in 6 cases, and the median time to recurrence is 7 months (2–21 months). Treatment was performed in all 6 cases after recurrence. Four patients had radiation therapy, but their prognosis was severe: 2 cases survived and 4 cases died.

Conclusion
Conversion surgery as a multidisciplinary treatment still can not provide a satisfactory prognosis, so additional treatment strategies including radiation and more effective utilization of other modalities are expected.
292 PREOPERATIVE RISK STRATIFICATION IN ESOPHAGEAL SURGERY: COMPARING RISK MODELS WITH THE CLINICAL JUDGEMENT OF THE SURGEON
Authors: Hagens Eliza , Cui Nanke , Eshuis Wietse , Laméris Wytze , Berge Henegouwen Mark , Gisbertz Suzanne 
Published: September 2021

Abstract

Numerous prediction models have been proposed to estimate the risk of complications after esophagectomy. However, these models are not commonly used in practice and surgeons generally trust on their own clinical judgment. The aim of this study is to compare the clinical judgment of the surgeons with the existing risk stratification models with regard to predicting complications after esophageal surgery.

Methods
Patients with resectable esophageal cancer who underwent an esophagectomy between March 2019 and January 2020 were included in this prospective study. Literature was searched to identify prediction models predicting the incidence of postoperative complications after esophagectomy. Clinical judgment of three surgeons was assessed using a standardized form where surgeons could indicate their estimated risk for postoperative complications. The best performing prediction model was compared with the judgment of the surgeons, using the Net Reclassification Improvement (NRI). A higher NRI correlates with better estimation by the surgeon and a negative NRI indicates a better prediction by the prediction model.

Results
Fifty-three patients were included, 36 patients (68%) developed a complication. Two risk classification models were identified in literature: Model 1 (Lagarde et al, Annals of thoracic surgery, 2008) and model 2 (Reeh et al, Medicine, 2016). Model 1 had a better discriminative ability than model 2 (Area Under the Receiver Operator Curve 0.738 versus 0.609). The NRI for the surgeons combined was −2%, meaning that model 1 outperforms the combined judgment of the surgeons. However, there was a large difference in clinical judgment between surgeons. Figure 1 shows the NRI for all three surgeons separately.

Conclusion
Surgeons‘assessment does not outperform prediction models in predicting the incidence of postoperative complications after esophageal surgery. However, there is a poor agreement between surgeons regarding their risk assessment based on their clinical judgment. Some surgeons might individually outperform existing risk stratification models. Surgeon’s assessment can therefore still be important when counseling patients about the risks of esophageal surgery in addition to risk stratification models.