bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.097: A CASE OF IGG4-RELATED SCLEROSING ESOPHAGITIS
Authors: Miki Hirokazu , Michiura Taku , Mukaide Hiromi , Inoue Kentaro , Yamamichi Keigo , Hamada Madoka 
Published: September 2018

Abstract

Background
IgG4-related disease (IgG4-RD) is a systemic disease characterized by fibrosing inflammation with an abundance of IgG4-positive plasma cells. IgG4-RD has been found to affect various organs. Many cases of IgG4-RD affecting the extrapancreatic organs have been reported in patients without pancreatic lesions.

Methods
Sclerosing esophagitis with IgG4-positive plasma cell infiltration is very rare disease. We report a case of esophageal benign stricture that was difficult to diagonose.

Results
A 76-year-old woman had been experiencing slight difficulty in swallowing in the 3 years prior to this presentation. Her dysphagia had progressed and she began to vomit frequently after meals and lost weight while hospitalized after surgery for cervical cancer. Esophagogastroduodenoscopy and an esophagram showed circumferential erosion and a stricture of the thoracic esophagus. No malignant cells were identified. However, because it was difficult to exclude a malignant tumor, she underwent esophageal resection. The resected specimen showed stricture with mucosal erosion and transmural wall hypertrophy. On histological examination, transmural hyperplasia consisting of inflammatory granulation tissue with abundant infiltration of IgG4-positive plasma cells and lymphocytes was observed.

Conclusion
A probable diagnosis of IgG4-related disease was made because comprehensive diagnostic criteria for this condition were met. IgG4-related esophageal disease presenting as esophageal lesions alone is very rare.

Disclosure
All authors have declared no conflicts of interest.
PS01.098: EMERGENCY COMPUTED TOPMOGRAPHY PREDICTS CAUSTIC ESOPHAGEAL STRICTURE FORMATION
Authors: Chirica Mircea , Bruzzi Matthieu , Resche Rigon Matthieu , Corte Helene , Voron Thibault , Sarfati Emile , Marie Zagdanski Anne , Cattan Pierre 
Published: September 2018

Abstract

Background
Endoscopy is the best predictor of stricture formation after caustic ingestion. Our aim was to compare the accuracy of emergency CT and endoscopy in predicting risks of esophageal stricture.

Methods
We describe a CT classification of esophageal caustic injuries: Grade I show normal esophagus; Grade IIa display internal enhancement of the esophageal mucosa and enhancement of the outer wall conferring a ‘target’ aspect; Grade IIb present as a fine rim of external esophageal wall enhancement. In 152 patients (56 males, median age 45) who underwent esophageal preservation after caustic ingestion we compared the accuracy of the CT and endoscopic (Zargar) classifications in predicting esophageal stricture.

Results
On endoscopy esophageal injuries were classified as grade 1(n = 50; 33%), grade 2a n = 11; 7%), grade 2b (n = 19; 13%), grade 3a (n = 14; 9%) and grade 3b (n = 58; 38%). On CT, 47 (31%) patients had grade I, 47 (31%) had grade IIa and 58 (38%) had grade IIb esophageal injuries. Fifty-six (37%) patients developed esophageal strictures. The risk of esophageal stricture formation was 0%, 17% and 83%, for grade I, IIa and IIb CT injuries and 0%, 0%, 28%, 50% and 76% for endoscopic grade 1, 2a, 2b, and 3a and 3b injuries, respectively. ROC curve analysis at 120 days after ingestion showed that CT outperformed endoscopy in predicting stricture formation (P = 0.047) and did just as well as a combined CT-endoscopy algorithm (P = 0.73).

Conclusion
Emergency CT outperforms endoscopy in predicting esophageal stricture formation after caustic ingestion. Emergency endoscopy evaluation after caustic ingestion is not indispensable.

Disclosure
All authors have declared no conflicts of interest.
PS01.102: MINIMALLY INVASIVE ENUCLEATION OF ESOPHAGEAL LEIOMYOMA: COMPARISON OF DIFFERENT TECHNIQUES WITH FOCUS ON QUALITY OF LIFE AND GASTROESOPHAGEAL REFLUX
Authors: Milito Pamela , Aiolfi Alberto , Zanghi Simone , Siboni Stefano , Asti Emanuele , Bonavina Luigi 
Published: September 2018

Abstract

Background
Minimally invasive enucleation of esophageal leiomyoma may induce or aggravate gastroesophageal reflux disease, but scarce data are available in literature.

Methods
We conducted a retrospective, cross-sectional single-center study investigating long-term outcomes of laparoscopic, thoracoscopic, and endoscopic enucleation with focus on quality of life and gastroesophageal reflux. Postoperative clinical and endoscopic data were compared to baseline. All patients underwent barium swallow study, endoscopy and completed the GERD-HRQL questionnaire after a minimum 1-year follow-up.

Results
Thirty patients were included in the study. There were 19 females and 11 males, median age 48 years (range 28–67). Thirteen (43.3%) patients underwent laparoscopic enucleation plus fundoplication (9 Toupet, 3 Nissen, 1 Dor), 12 (40%) patients thoracoscopic enucleation, and 5 (16.7%) patients endoscopic enucleation. Mean operative time was 149.1 ± 62.6 min. Mean tumor diameter was 5.4 ± 3.2 cm. There was no operative mortality. Overall morbidity rate was 16.6%, and no mucosal perforations occurred. Mean hospital stay was 4.0 ± 1.8 days. The mean baseline GERD-HRQL score was 4.25 (range 0–21) in the laparoscopic group, 3.4 (range 0–12) in the thoracoscopic group, and 5.7 (range 0–13) in the endoscopic group. Preoperatively, hiatal hernia was present in 6 patients (46.1%) in the laparoscopic group, in 4 patients (33.3%) in the thoracoscopic group, and in 2 patients (40%) in the endoscopic group. The mean follow-up was 58 months (range 3–192) (Table 1).

Conclusion
GERD symptoms were more common in patients after endoscopic enucleation. Primary laparoscopic enucleation combined with fundoplication allows effective long-term reflux control.

Disclosure
All authors have declared no conflicts of interest.
PS01.107: INTERDISCIPLINARY MANAGEMENT OF AORTO-ESOPHAGEAL FISTULA: BETTER SAFE THAN SORRY
Authors: Gschwandtner Elisabeth , Fink-Neuböck Nicole , Lindenmann Jörg , Porubsky Christian , Maier Alfred , Portugaller Rupert , Oberwalder Peter , Deutschmann Hannes , Dapunt Otto , Smolle-Jüttner Freyja-Maria 
Published: September 2018

Abstract

Background
Aorto-esophageal fistula is a rare but life-threatening event evolving spontaneously or—more often—following therapeutic interventions at the esophagus or the aorta. Especially in presence of long-standing inflammation preceding the formation of the fistula, acute surgical closure of the aortic leakage is all but impossible and interdisciplinary treatment is mandatory.

Methods
Review of cases of aorto-esophageal fistula within the last 12 years.

Results
In our collective of patients undergoing esophagectomy since 2005 (N = 445) we observed 7 cases (1,5%) of aorto-esophageal fistula. In one case the fistula had developed spontaneously following aspergillosis, one patient had had aortic stenting 29 years before, another one had developed anastomotic dehiscence following intrathoracic esophago-jejunostomy and in 4 cases esophageal stenting had been done. 5 patients presented with slight to dramatic hematemesis which in 2 instances needed endoscopic intervention, 2 had no bleeding. Preoperative angio-CT confirmed aorto-esophageal fistula in 3 cases who underwent aortic stenting prior to the surgical intervention, in 3 patients the fistula was found intraoperatively (aortic replacement N = 1; suture followed by stenting N = 1; operation stopped; aortic stenting, operation the following day). All patients recovered from surgery. In one case inflammation had caused partial necrosis of the aortic wall causing fatal bleeding during operation. Retrospectively, the lesion of the aortic wall could be identified on CT in all but one patient.

Conclusion
By interdisciplinary management, involving preoperative stenting or aortic graft implantation in cases not amenable to stenting, patients with aorto-esophageal fistula can be saved and may undergo elective esophageal surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.108: SPONTANEOUS ESOPHAGOCUTANEOUS FISTULA IN KIKUCHI DISEASE
Authors: Voon Kelvin , Mohammed Taher Mustafa , Rajan Reynu , Ritza Kosai Nik 
Published: September 2018

Abstract

Background
Kikuchi disease is a rare, self-limiting condition that is characterized by histiocytic necrotizing lymphadenitis with unknown pathogenesis. Common presentation is cervical lymphadenopathy and fever in a previously well young female. Mediastinal lymph node involvement is uncommon.

Methods
We report a case of spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymphadenopathy in a patient with Kikuchi disease.

Results
A 38-year-old lady presented with fever and right back pain of two weeks duration. She had background history of Kikuchi disease which was diagnosed 1 year ago. Examination revealed multiple enlarged left cervical lymph nodes and right back tenderness. CT scan showed an esophagocutaneous fistula with right paraspinal abscess and multiple enlarged cervical and mediastinal lymph nodes. OGDS revealed a 5mm fistula opening at right posterior wall of distal esophageal, 3cm proximal to esophagogastric junction. Rest of esophagus and stomach were normal. Tuberculosis and SLE workup were negative. Cervical lymph node biopsy was consistent with Kikuchi disease. She was treated as spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymph node with underlying Kikuchi disease. Percutaneous drainage of paraspinal abscess was done and antibiotics were commenced. Laparoscopic feeding jejunostomy was done for feeding. Esophageal stenting and endoscopic clipping of fistula were attempted but the fistula tract persisted. She then underwent laparoscopic excision of esophageal fistula tract (LEEFT). Intraoperative findings were dense inflamed paraesophageal tissue with thickened fistula tract at right posterolateral wall of distal esophagus with multiple enlarged mediastinal lymph nodes. Fistula tract and the lymph nodes were excised via laparoscopic transhiatal approach. She had an uneventful recovery and was discharged on post-operative day 7.

Conclusion
Spontaneous esophageal fistula is rare and necrotizing mediastinal lymphadenopathy needs to be considered. Laparoscopic excision of esophageal fistula tract (LEEFT) is a novel transhiatal approach and it is feasible in distally located fistula.

Disclosure
All authors have declared no conflicts of interest.
PS01.112: ESOPHAGEAL AORTIC FISTULA TREATED BY ESOPHAGOSCOPY COMBINED WITH AORTIC ENDOVASCULAR GRAFT EXCLUSION
Authors: Tang Shoujun , Zhou Haining 
Published: September 2018

Abstract

Background
The esophageal aortic fistula is an uncommon disease caused by a foreign matter in the esophagus. This condition presents a high mortality, and inappropriate treatment can result in serious consequences.

Methods
A 66-year-old male patient was admitted to a hospital because of frequent dysphagia and severe chest pain after eating fishbone 5 days ago. In another hospital, the patient underwent gastroscopy, which revealed that a fishbone was incarcerated in the esophageal wall 23 cm away from the incisor and was causing active bleeding. The fishbone was not successfully removed in this hospital. A CT scan of the thorax performed in our department indicated an esophageal striped high-density shadow (below the aortic arch). The borders of the thoracic aortic wall were unclear. On the basis of these findings, the patient was diagnosed with esophageal aortic fistula. The doctors in the otolaryngology department failed to remove the fishbone by esophagoscopy because of jet-like bleeding. An esophageal gasbag was immediately used for hemostasis by compression. Afterward, thoracic surgeons performed ascending aorta angiography, which showed an approximately 1.0 cm anabrosis in the lesser curvature of the initial part of the descending aorta. The covered stent was placed, and the fishbone was removed successfully by esophagoscopy.

Results
The patient was able to eat normally after 7 days postoperatively. No significant abnormality was reported in the following 3 years.

Conclusion
An esophageal aortal fistula caused by a foreign matter should be operated on immediately if the physical condition of the patient permits. The location of the foreign matter and its relationship to the large blood vessels can be detected by high-resolution computed tomography and computed tomography angiography. Stent implantation reduces the risk of massive hemorrhage. Therefore, we recommend esophagoscopy combined with aortic endovascular graft exclusion as a safe alternative.

Disclosure
All authors have declared no conflicts of interest.
PS01.113: RISK FACTORS FOR ESOPHAGEAL STRICTURE IN GRADE 2B AND 3A CORROSIVE ESOPHAGEAL INJURIES
Authors: Mahawongkajit Prasit 
Published: September 2018

Abstract

Background
Ingestion of corrosive agents remains an important public health problem. Early endoscopic examination of post-corrosive esophageal injuries has an important role in management of the patient. Publications document the risk of developing esophageal stricture as a sequential complication of esophageal injury grades 2b and 3a. Although there are studies describing the risk factors of post-corrosive stricture, there is limited literature on these factors. The aim of this study was to evaluate the different factors with post-corrosive esophageal stricture and non-stricture groups in endoscopic grades 2b and 3a of corrosive esophageal injuries.

Methods
Data were retrospectively analyzed in the patients with esophageal injury grades 2b and 3a between January 2011 and December 2017.

Results
196 corrosive ingestion patients were admitted with 32 patients (15.8%) in grade 2b and 12 patients (6.1%) in grade 3a and stricture was developed in 19 patients (61.3%) with grade 2b and in 10 patients (83.3%) with grade 3a. Substances of alkaline reaction were predominant in stricture patients (68.4% in 2b Stricture group, 60% in 3a Stricture group). The patients’ height of non-stricture group was greater than that of stricture groups (2b Stricture group, 1.58 ± 0.08 m, 2b Non-stricture group, 1.66 ± 0.07 m, P < 0.004; 3a Stricture group, 1.52 ± 0.09 m, 3a Non-stricture group, 1.71 ± 0.02 m, P < 0.001). Omeprazole was more commonly used in non-stricture than stricture group (26.3% in 2b Stricture group, 69.2% in 2b Non-stricture group, P = 0.017; 50% in 3a Stricture group, 100% in 3a Non-stricture group, 1.71 ± 0.02 m, P = 0.015).

Conclusion
In this study, the corrosive esophageal injuries grades 2b and 3a are important groups of patients who are at risk of developing post-corrosive esophageal stricture. Alkaline substances play the major role in stricture sequelae. The height of patients and the prescription of omeprazole may help to minimize the risks of post-corrosive esophageal stricture.

Disclosure
All authors have declared no conflicts of interest.
PS01.115: ESOPHAGECTOMY FOR ACHALASIA CARDIA: A SINGLE TEAM EXPERIENCE
Authors: Chandramohan Servarayan , Manickavasagam Kanagavel , Chinnathambi Madeshwaran , Jebaraj Abishai , Chandramohan Apsara , Devygounder Kannan , Varadharajan Visvarath 
Published: September 2018

Abstract

Background
In the era of per oral endoscopic myotomy, advancement in manometry and laparoscopy the treatment for achalasia cardia is well defined. Oesophagectomy has only a limited role in rare patients with sigmoid esophagus, perforation during nonsurgical treatment and malignancy. This study is about the indications of esophagectomy for achalasia cardia from one of the high volume centers for upper gastrointestinal disorders in India

Methods
This study includes 10 patients (7 male, 3 female) between august 2010 to august 2016.They had symptoms like dyspnea, dysphagia, regurgitation, chest discomfort, weight loss and cough. The duration of symptoms range from 2–120 months. Seven patients underwent previous pneumatic dilatation, four underwent Laproscopic Hellers cardiomyotomy with fundoplication (dor 3, toupet 1) and one patient had both pneumatic dilatation and cardiomyotomy.

Results
The indications for esophagectomy were sigmoid esophagus, failed pneumatic dilatation and laproscopic hellers cardiomyotomy, perforation after pneumatic dilatation and malignancy. The procedures done were transhiatal esophagectomy with stomach pull-up in 8 patients, Transthoracic esophagectomy in one, Esophagogastrectomy with transabdominal intrathoracic esophagojejunal anastomosis in one patient. The follow-up range between 14–84 months. During follow-up one patient developed hepatocellular carcinoma right lobe and died.

Conclusion
In the era where nonresection treatment play a major role in the management of achalasia cardia, esophagectomy still has a role in select patients. The indications for esophagectomy in our series included failed endotherapy, failed Hellers cadiomyotomy, sigmoid esophagus and malignancy.

Disclosure
All authors have declared no conflicts of interest.
PS01.116: EXTRAMUCOSAL ENUCLEATION IS SAFE AND FEASIBLE IN ESOPHAGEAL LEIOMYOMA IRRESPECTIVE OF SIZE: SINGLE INSTITUTION EXPERIENCE
Authors: Perwaiz Azhar , Singh Amanjeet , Chaudhary Adarsh 
Published: September 2018

Abstract

Background
Esophageal leiomyoma (EL) is the most common benign lesion of esophagus. Extramucosal enucleation (EME) is the treatment of choice however esophageal resection have been favoured by some particularly when they attain large size citing risk of malignant transformation. We share our experience of EME over the last 7 years.

Methods
Prospectively collected database on consecutive cases of EL managed surgically between March 2010 and March 2017 were analysed retrospectively. Our department policy is to consider EME in all. Routine preoperative workup included baseline blood tests, contrast enhance computed tomography chest and upper abdomen and endoscopic ultrasound. All perioperative details were recorded prospectively. All patient underwent CT with oral contrast on day 1 of surgery to exclude leak. Final histopathology were recorded and all of them were followed 6 monthly.

Results
Mean age of the patients analysed (n = 21; male = 16, female = 5) were 42.7 ± 10.7 years (range 22 to 61) with mean tumor size of 8.4 ± 2.8cm (range 4.2 to 15). Commonest tumour location was thoracic esophagus (n = 16; 76.1%) followed by abdominal (n = 4; 19.2%) and cervical esophagus (n = 1; 4.7%). Most tumor were asymptomatic (n = 9/21; 42.8%) while dysphagia was commonest among those who had symptoms at presentation(7/21; 33.3%). Five (23.8%) of these were of size ≥ 10 cm (giant EL). All of them underwent EME as planned. Majority (n = 17; 81%) underwent minimally invasive enucleation (Thoracoscopic = 14, Laparoscopic = 3) while rest 4 (19%) underwent open enucleation due to large size in 1, cervical location in 1 and intolerance to minimally invasive procedure in 2. The mean operative blood loss were 72.5 ± 22 ml and none required blood transfusion. The mean duration of surgery were 122 ± 27 minutes. There were no postoperative complications that required intervention. No leak reported on postoperative day 1 scan. All patients got discharged by a mean of 5.2 ± 1.8 days. The final diagnosis were leiomyoma in all. At a mean follow up of 36 ± 17.2 months none had recurrence or any long term complication attributable to enucleation.

Conclusion
Extramucosal enucleation is safe in esophageal leiomyoma irrespective of size and majority of them can be managed with minimally invasive surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.125: SURGICAL APPROACH FOR THE ELDER ESOPHAGEAL CANCER
Authors: Tashiro Keitaro , Kawai Masaru , Lee Sang-Woong , Tanaka Ryo , Imai Yoshiro , Hiramatsu Masako , Uchiyama Kazuhisa 
Published: September 2018

Abstract

Background
Recently the number of elder patients who have esophageal cancer has been higher in Japan. Because the anesthesia and surgical technique are developing day by day, we can choose surgery as radical therapy for esophageal cancer in elder patients. But the percentage of complication after operation in elder person still should be higher compared to young person. We present the problems and the risks of surgery for elder esophageal cancer in our institution.

Methods
61 patients (over 75 years old) who had esophageal cancer underwent esophageal resection from 1998 to 2016 in Osaka Medical College, Japan. We divided these patients to 3 groups: open surgery; Group A, none open surgery (trans hiatal approach); Group B, VATS (Video-Assisted Thoracic Surgery); Group C, and assessed the amount of blood loss and surgical time during operation and the frequency of complication after operation.

Results
Average age of patient in Group B was significantly higher than other groups (Group A: 78.7 y. o., Group B: 81.3 y. o., Group C: 77.5 y. o.). Surgical time in Group C (526.5 ± 20.7min) was significantly longer than other groups (Group A: 385.5 ± 17.9min, Group B: 297.1 ± 27.4min). Blood loss during operation in Group B tended to be less than other groups (Group A: 575.4 ± 105.4mL, Group B: 320.4 ± 61.0mL, Group C: 317.6 ± 80.3mL). The complication after surgery occurred in 27 patients (44.3%) in whole groups, including pneumonia (48.8%), anastomotic leakage (18.6%), recurrent nerve paralysis (16.3%), empyema (7.0%), ischemia of gastric tube and/or small intestine (4.7%), deep venous thrombosis (4.7%). According to surgical approach, the occurring frequency of pneumonia (Clavien-Dindo classification Grade III and more) after operation in Group A (28.6%) was higher than other group (Group B: 8.3%, Group C: 9.5%), but more recurrent nerve paralysis was occurred in Group C (33.3%) compared to other groups.

Conclusion
Lung diseases including pneumonia, particularly in elder patient, are one of the most critical and sometimes become a fatal complication after esophageal cancer surgery. VATS seems to be more safe and useful approach in elder esophageal cancer resection, but needs to be care for recurrent nerve paralysis.

Disclosure
All authors have declared no conflicts of interest.
PS01.126: LYMPH NODE METASTASES AND NECK DISSECTION FOR THE PATIENTS WITH CERVICAL ESOPHAGEAL CANCER
Authors: Shiga Kiyoto , Katagiri Katsunori , Saito Daisuke 
Published: September 2018

Abstract

Background
Cervical esophageal cancer (CEC) is a relatively rare disease but the outcomes of the patients with CEC are often poor. Lymph node metastases in the neck sometimes play a crucial role to treat the patients. The aim of this study is to evaluate the lymph node metastases and neck dissection for the patients with CEC.

Methods
Retrospective review of the records of the patients. Five patients with CEC who underwent total pahryngo-laryngectomy plus cervical esophagectomy were enrolled in this study. We analyzed the places of lymph node metastases of the patients and the relationship of the patients’ outcome.

Results
Four of the patients underwent free jejunum flap reconstruction after total pahryngo-laryngectomy plus cervical esophagectomy and the other one underwent gastric tube plus free jejunum flap reconstruction after the pahryngo-laryngectomy plus total esophagectomy. All patients underwent bilateral neck dissection. One patient underwent chemoradiotherapy as an initial treatment and he had no lymph node metastasis by pathological examination. The other four patients had neck metastases to some extent. Three of them had bilateral lymph node metastases and the other had one metastatic lymph node. Especially one patient had left upper lateral neck metastasis and right Rouvier lymph node metastasis.

Conclusion
These results indicated that patients with CEC should undergo bilateral neck dissection and if possible, Rouvier lymph node should also be resected during radical surgery.

Disclosure
All authors have declared no conflicts of interest.