bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA05.06: CHANGES IN SKELETAL MUSCLE AND PHYSICAL FUNCTION AFTER ESOPHAGECTOMY: PROSPECTIVE SINGLE-CENTER COHORT STUDY
Authors: Nishigori Tatsuto , Tsunoda Shigeru , Obama Kazutaka , Kobayashi Ami , Nobori Yukiko , Hisamori Shigeo , Hashimoto Kyoichi , Itatani Yoshiro , Tashiro Naohiro , Shide Kenichiro , Inagaki Nobuya , Sakai Yoshiharu 
Published: September 2018

Abstract

Background
Sarcopenia (loss of muscle mass) has been shown to be associated with postoperative outcomes following esophagectomy. However, the impact of esophagectomy on postoperative muscle mass and function remains unclear. The prospective study aimed to evaluate the change in muscle mass and physical function after esophagectomy in sarcopenic patients in comparison with nonsarcopenic patients.

Methods
The subject of the study was patients with cStage I-III primary esophageal cancer who were scheduled to undergo curative esophagectomy. Sarcopenia was diagnosed by measuring preoperative muscle mass with bioelectrical impedance analysis. Physical function was evaluated by measuring grip strength and walking speed. Postoperative muscle mass and function were evaluated between 1 and 3 months after surgery. Perioperative changes in muscle mass and function were compared between patients with and without sarcopenia

Results
Among all 71 enrolled patients, 30 (41%) had sarcopenia. Sarcopenic patients had significantly lower muscle strength (34 vs 41 kg in male, 21 vs 26 kg in female) and a higher rate of postoperative complications (Clavien-Dindo grade 2 or higher, 77% vs 49%, P = 0.018) compared to nonsarcopenic patients. Sarcopenic patients had a trend to lose greater amount of grip strength (-10.0% vs -5.6%, P = 0.10) and walking speed (-8.2% vs -1.1%, P = 0.18), while muscle mass decreased generally in both sarcopenic and nonsarcopenic patients (-8.0% vs -6.8%, P = 0.46).

Conclusion
Sarcopenic patients had a higher risk of postoperative complication and may lose further physical function following esophagectomy. Perioperative interventions such as nutrition exercise therapy should be considered for sarcopenic patients.

Disclosure
All authors have declared no conflicts of interest.
RA05.07: ESOPHAGEAL RECONSTRUCTION BY PEDICLED TERMINAL ILEUM AND RIGHT COLON WITH PRESERVED ILEOCOLIC VESSELS
Authors: Hiramatsu Masako , Kobayashi Toshihiro , Tsunematsu Ichiro , Kono Emiko , Imai Yoshiro , Suzuki Yusuke , Kawai Masaru , Tashiro Keitaro 
Published: September 2018

Abstract

Background
In the case of esophageal cancer patient whose stomach is not available for reconstruction, we had been using pedicled jejunum for lower esphageal cancer or right colon reconstruction as an alternative. However, high incidence of postoperative anastomotic leakage regarding insufficient blood supply was a great distress. We started the unique reconstruction technique using terminal ileum and right colon with preserved ileocolic vessels in 2011. Based on our experience, we considered benefits of our method.

Methods
After esophagectomy and lymphadenectomy, the ascending colon was mobilized. The mid colic, right colic (if exist) and ileocolic vessels, as well as marginal vessels of terminal ileum, were preserved, the ileum was cut at the point approximately 20–30cm from the ileum end. The final ileal artery and vein may be ligated and cut, if necessary. The pedicled ileo-colon was, then, carefully lifted isoperistaltically via subcutaneous route. Esophagoileostomy was usually performed by functional end to end anastomosis. Additional anastomoses were performed by Billroth II or Roux en Y method.

Results
In total of 383 patients who were underwent transthoracic esophagectomy between 1998 and 2017, 15 pedicled jejunum (J), 4 traditional right colon (C) and 6 ileo-colon preserved ileocolic vessels (IC) were used for reconstruction. The incidence of esophagoileostomy-related complications were 6.7% (1/15) in J, 50.0% (2/4) in C and 33.3% (2/6) in IC. One in IC showed ileal necrosis caused by sclerotic obstruction on the root of ICA, then remained right colon was used for free flap salvage reconstruction. Two in C suffered from pneumonia at early post-operative days, probably because of microaspiration of colic bacterium, interestingly, there was no caces of pneumonia in IC. In addition, the subcutaneous space was occupied only with the ileum, therefore the antesternal skin bloating was not bulky.

Conclusion
The advantages of our technique are; i) less anastomotic complications, ii)possibility of less aspiration pneumonia, iii) better cosmetic appearance, and iv) no microvascular surgery required. Our technique could be used as the standard method of reconstruction after esophagectomy for patients in whom stomach is not available.

Disclosure
All authors have declared no conflicts of interest.
RA06.01: PATHOLOGICAL IMPLICATIONS OF SWALLOW-ASSOCIATED TRANSIENT LOWER ESOPHAGEAL SPHINCTER ELEVATION
Authors: Masuda Takahiro , Kovacs Balazs , Bremner Ross , Mittal Sumeet 
Published: September 2018

Abstract

Background
We have previously reported that swallow-induced transient hiatal hernia (tHH) is associated with pathological gastroesophageal reflux. In this study, we built upon our previous study of tHH, assessing the pathological implications of swallow-induced tHH in a new, larger cohort.

Methods
We queried a prospectively maintained database to identify patients who underwent both 24-hour pH monitoring and high-resolution manometry (HRM) between January 2017 and December 2017. We excluded patients with end-stage lung disease, inadequate LES relaxation, major esophageal motility disorders, or manometric hiatal hernia. Significant swallow-induced LES–CD separation was defined as ≥ 1 cm separation in ≥ 30% swallows or ≥ 2 cm separation in ≥ 10% swallows. We used HRM to separate patients into 3 groups, as follows: 1. Persistent tHH (p-tHH): Significant LES–CD separation at the 2nd inspiration after the conclusion of swallow-induced esophageal peristalsis. 2. Incident tHH (i-tHH): Significant LES–CD separation at the 1st inspiration after the conclusion of peristalsis without meeting p-tHH criterion. 3. Non-tHH: Neither p-tHH nor i-tHH was observed.

Results
In total, 472 patients underwent both HRM and a 24-hour pH study during the study period. Of these, 74 patients met inclusion criteria. The mean age was 51.6 years, and 45 patients (60.8%) were women. Forty-two patients (56.8%) had an abnormal DeMeester score (ie, > 14.72). Fourteen patients (18.9%) were categorized into the p-tHH group, 36 (48.6%) were in the i-tHH group, and 24 (32.4%) were in the non-tHH group. LES pressure, LES pressure integral, esophageal peristaltic vigor, and prevalence of dysmotility were similar among the groups. No significant differences were observed in the pH studies for patients with i-tHH and non-tHH; however, patients in the p-tHH group had a higher prevalence of abnormal DeMeester score and longer total acid reflux time than patients in the non-tHH cohort (78.6 vs 45.8%, P < 0.05; 8.0 vs 3.8%, P = 0.016, respectively).

Conclusion
We confirm that p-tHH is associated with pathological distal esophageal acid exposure and appears to be an early indicator of LES dysfunction.

Disclosure
All authors have declared no conflicts of interest.
RA06.06: PATHOGENESIS OF POTASSIUM-COMPETITIVE ACID BLOCKER (P-CAB)-RESISTANT NON-EROSIVE REFLUX DISEASE, AND GASTRIC ACID SECRETION-INHIBITORY EFFECTS OF P-CAB
Authors: Kawami Noriyuki , Hoshino Shintaro , Hoshikawa Yoshimasa , Kaise Mitsuru , Iwakiri Katsuhiko 
Published: September 2018

Abstract

Background
In PPI-resistant NERD patients with symptoms related to acid reflux due to insufficient acid suppression, the symptoms may be improved by the administration of potassium-competitive acid blocker (P-CAB), which is a potent acid inhibitor. However, there are patients with P-CAB-resistant NERD, in whom symptoms persist despite the administration of P-CAB. The objective of this study was to clarify the pathogenesis of P-CAB-resistant NERD.

Methods
Forty-three patients with NERD (20 males, mean age 57.7 ± 2.5 years old), who had persistent reflux symptoms despite the administration of P-CAB (vonoprazan, 20 mg/day for 2 to 4 weeks), were included in this study. After excluding eosinophilic esophagitis (EoE) and primary esophageal motility disorders, esophageal impedance-pH monitoring was performed on P-CAB therapy. The relationship between reflux and symptoms was evaluated according to the symptoms index (SI). Reflux episodes were characterized by pH measurement as acid, weakly acidic or weakly alkaline according to a published consensus report. In symptom index (SI)-positive patients, the mechanism of SI positivity and percent time with intragastric pH > 4 and with esophageal pH < 4 were investigated according to the presence or absence of Helicobacter pylori infection.

Results
One (2.3%) of 43 patients had a primary esophageal motility disorder (Jackhammer esophagus). Eighteen (41.9%) and 3 (7%) patients were SI-positive for liquid- and gas-only reflux, respectively, and the remaining 21 patients who were SI-negative (48.8%) had functional heartburn. All patients SI-positive for liquid reflux were SI-positive for weakly acidic reflux. The percent time with intragastric pH > 4 and esophageal pH < 4 were 98.1 ± 0.8% and 0.18 ± 0.1% (mean ± SE), respectively, in H. pylori-positive patients and 79.9 ± 4.3% and 0.28 ± 0.1%, respectively, in H. pylori-negative patients, demonstrating that gastric acid was sufficiently suppressed by P-CAB regardless of the presence or absence of H. pylori infection.

Conclusion
The pathogenesis of P-CAB-resistant NERD was elucidated in 51% of patients. Symptoms in all patients SI-positive for liquid reflux were related to weakly acidic reflux, and symptoms related to acid reflux may be ruled out by the administration of P-CAB.

Disclosure
All authors have declared no conflicts of interest.
RA06.08: PATIENTS WITH FUNCTIONAL REFLUX SYMPTOMS DO NOT DIFFER SUBJECTIVELY FROM PATIENTS WITH GERD
Authors: Ciftci Sedat , Weitzendorfer Michael , Kalcheva Dariya , Manzenreiter Lisa , Emmanuel Klaus , Koch Oliver 
Published: September 2018

Abstract

Background
Patients with gastroesophageal reflux disease (GERD) often suffer greatly from their symptoms. The aim of this study was to determine if there is a difference in quality of life and gastrointestinal symptom complexes between patients with purely functional complaints and patients with objective GERD

Methods
Included were all patients with typical reflux symptoms who had GERD examination in 2017 at our department. All patients underwent high resolution manometry, 24-h ph-metry impedance measurement and gastroscopy. Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI) and gastrointestinal symptoms using a Symptom Checklist (SCL) assessing the severity and intensity of 14 different symptoms. Based on the results of the 24-h ph-metry impedance measurement, patients were divided into 2 groups. Patients with functional reflux symptoms and patients with GERD. These two groups were compared.

Results
Complete data was available in 162 patients, of whom 86 patients (52.2%) were objectively reflux sick (DeMeester score mean: 37.85, SD ± 29.11) and 76 patients (46.1%) had a normal DeMeester score (Mean: 7.01, SD ± 4.09). Between the two groups no significant difference in quality of life was found (mean GIQLI of GERD patients: 94.81, SD ± 22.40, and mean GIQLI of patients with functional reflux symptoms: 95.26, SD ± 20.33, P = 0.988).Furthermore no significant difference could be found in symptoms (mean general SCL score of reflux patients:46.97, SD ± 29.23, of patients with functional reflux symptoms: 48.03, SD ± 29.17, P = 0.827).

Conclusion
Patients with functional complaints suffer just as much from their symptoms as patients who are objectively reflux sick. A differentiation between gastroesophageal reflux disease and functional reflux symptoms is only possible by means of functional diagnostics.

Disclosure
All authors have declared no conflicts of interest.
RA06.09: MAGNETIC SPHINCTER AUGMENTATION VERSUS LAPAROSCOPIC NISSEN FUNDOPLICATION: A MATCHED-PAIR ANALYSES OF 186 PATIENTS
Authors: Nikolic Milena , Schwameis Katrin , Kristo Ivan , Semmler Georg , Semmler Lorenz , Steindl Ariane , Schoppmann Sebastian 
Published: September 2018

Abstract

Background
Magnetic sphincter augmentation (MSA) has been proven a safe and efficient alternative to laparoscopic Nissen fundoplication (LNF) in patients with gastro-intestinal reflux disease (GERD). Aim of this study was to compare the matched outcome of patients with GERD following MSA and LNF, respectivelyMagnetic sphincter augmentation (MSA) has been proven a safe and efficient alternative to laparoscopic Nissen fundoplication (LNF) in patients with gastro-intestinal reflux disease (GERD). Aim of this study was to compare the matched outcome of patients with GERD following MSA and LNF, respectively

Methods
Out of a prospective database, an analysis was conducted including patients that underwent MSA and LNF, respectively, between 2012 and 2017 at our institution. Patients were matched using propensity scores including selected criteria. Postoperative outcomes were assessed through reflux-symptoms, proton pump inhibitor (PPI) intake, GERD-Health-related-Quality-of-Life (GERD-HRQL) and Alimentary Satisfaction (AS).

Results
From a total of 323 patients, 186 patients that met our inclusion criteria were matched. At a median follow-up of 1.5 years there was no difference in the GERD-HRQL (2.5 MSA vs. 1 LNF, P = 0.341), AS (8/10 MSA vs 9/10 LNF, P = 0.175), regular PPI-intake (15% MSA vs. 6% LNF, P = 0.058) or heartburn elimination (73% MSA and LNF) between the two groups. We observed similar side-effect rates concerning persistent dysphagia (1% MSA and LNF) and gas-bloating (17% MSA vs. 15% LNF, P = 0.690). However, in patients after MSA the ability to belch and/or vomit was higher (87% MSA vs. 70% LNF, P = 0.05).

Conclusion
Mid-term outcome of patients after MSA for the treatment of GERD is comparable to patients treated with LNF. Patients after MSA showed a higher ability to belch and/or vomit when compared to patients after LNF. This study encourages MSA as alternative first-line treatment in patients with non-severe GERD

Disclosure
All authors have declared no conflicts of interest.
RA07.01: CHANGE OF METABOLIC TUMOR VOLUME PREDICTS LONG-TERM SURVIVAL AND HISTOLOGICAL RESPONSE TO PREOPERATIVE CHEMOTHERAPY IN LOCALLY-ADVANCED ESOPHAGEAL CANCER
Authors: Makino Tomoki , Yamasaki Makoto , Tanaka Koji , Masuike Yasunori , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
The present study was aimed to assess the value of metabolic tumor volume (MTV) measured by 18F-fluorodeoxyglucose to evaluate response to neoadjuvant chemotherapy in patients with locally-advanced esophageal cancer (EC).

Methods
A total of 102 EC patients without distant metastasis who underwent 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) both before and after the series of preoperative chemotherapy were analyzed.

Results
The median value of MTV in primary tumor before and after preoperative chemotherapy were 22.55 (range: 0.4 -183.1) and 2.75 (0–52.9), respectively and the median reduction rate of MTV was 86.5%. The most significant difference in survival between PET responders and non-responders was at 60% of MTV reduction as a cutoff value based on every 10% stepwise cutoff analysis (2-year progression-free survival [PFS]: 79.2 vs 44.4%; hazard ratio [HR] = 3.397; P < 0.0001). With this cutoff value, histological complete response (P = 0.0091) in addition to tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, pM. Multivariate analysis further identified MTV reduction rate (HR = 2.471; P = 0.0263) but not decrease of primary lesion by CT or SUVmax reduction rate to be independent prognostic predictors along with pM (HR = 3.063; P = 0.0279).

Conclusion
By determining the optimal cutoff value based on survival analysis, change of MTV was shown to be clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients.

Disclosure
All authors have declared no conflicts of interest.
RA07.09: THE EFFICACY OF ASSESSING METASTATIC LYMPH NODES BY COMPUTED TOMOGRAPHY IN ADVANCED ESOPHAGEAL CANCER WITH NEOADJUVANT CHEMOTHERAPY
Authors: Urakawa Shinya , Makino Tomoki , Tanaka Koji , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Yamasaki Makoto , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
Although various modalities including CT, endoscopy, and positron emission tomography (PET) have been used to predict pathological tumor response (pTR) to neoadjuvant chemotherapy (NACT) or prognosis in esophageal cancer patients, an optimal method of response evaluation remains to be established.

Methods
A total of 97 non-T4 thoracic esophageal cancer patients who underwent curative surgery after NACT from 2011 to 2014 with both measurable primary tumors (PT) and metastatic lymph nodes (LNs) by CT (≥ 10mm in short axis or ≥ 5mm in short axis with SUV-max ≥ 2.5) were analyzed. Patients with ≥ 50% decrease in size of the PT (two-direction measurement) and ≥ 30% decrease in size of LNs (sum of short diameter based on RECIST criteria) were defined as PT- and LNs-responders, respectively.

Results
The median reduction rate of PT and LNs were 62.0% (5.5–93.4) and 26.7% (60.9–13.6), respectively. Of 97 patients, 62 (69%) and 45 patients (45%) were classified as PT- and LNs-responders respectively. The concordance rate between CT response of PT and LNs was 66% (P = 0.01). CT response of PT was correlated with pTR (P<0.0001) while CT response of LNs was associated with pT (P = 0.0011), pN(P = 0.0004), and pTR (P < 0.0001). Receiver operating characteristic (ROC) curves demonstrated the highest accuracy (AUC 0.75), sensitivity (88.9%) and specificity (60.9%) at the reduction rate of 53% (P = 0.007) which was approximated to the cutoff value we used. In univariate analysis of recurrence free survival (RFS), pT, pN, pM, CT response of both PT and LNs, and pTR were significantly correlated with RFS. Multivariate analysis further identified CT response of LNs (HR 2.68 P = 0.003) and pTR (HR 2.72 P = 0.022) to be independently associated with RFS. When classified into three groups by histological grade and CT response of LNs [group A (grade2–3/LNs-responders), group B (grade1a-1b/LNs-nonresponders), and group C (others)], 2-year RFS were 83% in the groupA, 59% in groupC and 29% in groupB (P < 0.0001), respectively.

Conclusion
In locally-advanced esophageal cancer patients with NACT followed by surgery, CT response of PT and LNs significantly correlated with pTR. Especially, CT response of LNs was important to predict prognosis in addition to pTR.

Disclosure
All authors have declared no conflicts of interest.
RA08.03: LYMPH NODE METASTASIS RISK IN SUPERFICIAL ESOPHAGOGASTRIC JUNCTIONAL ADENOCARCINOMA
Authors: Akazawa Naoki , Yamasaki Akira , Fujisaki Junko 
Published: September 2018

Abstract

Background
We have reported that lymph node metastasis risk in cases of superficial Barrett's esophageal cancer (BC) was of submucosal invasion within 500μm without other risk factors (lymphovascular involvement, a poorly differentiated component, and lesion size) through a multicenter retrospective study in 13 facilities. Cardiac cancer (CC) was included in the gastric cancer criteria of the Japanese Gastric Cancer Association. Since BC and CC near the esophagogastric junction (EGJ) show almost the same biological behavior, we elucidated the metastasis risk factors in patients with EGJ adenocarcinoma.

Methods
Patients who underwent ESD for superficial EGJ adenocarcinoma as Siewert typeII between January 2011 and April 2017 were included.

Results
A total of 120 patients were analyzed. Fifty-three patients (44.1%) had BC and 67 patients (55.8%) had CC. Of the 120 lesions, the median size was 16.7 ± 8.5 mm; 10 (8.3%; 4 BC, 6 CC) were greater than 30 mm in size. Thirty-five (29.1%; 17 BC, 18 CC) were submucosal (SM) cancers. Twenty-one (17.5%; 13 BC, 8 CC) had poorly differentiated components and 19 (15.8%; 14 BC, 5 CC) had lymphovascular involvement. Of the 19 cases with lymphovascular involvement, 11/22 (50%) were SM cancers with > 200μm of invasion, and 8/98 (8.1%) were mucosal (M)/SM cancers within SM200μm of invasion. Of the BCs with DMM invasion, 7/17 (41.1%) had lymphovascular involvement. Of the patients initially treated through ESD, 33 (27.5%) had lymphovascular involvement, positive horizontal/vertical margins, or SM > 200μm of invasion. Of these, 26 were treated with additional surgery. Metastasis was confirmed from 2 patients. Both were BCs, with SM > 501μm of invasion, positive lymphovascular involvement, and with poorly differentiated components. One was > 30 mm in size. Metastasis was not identified in CC and in cases with SM < 200μm of invasion.

Conclusion
For superficial esophagogastric cancer, we did not identify metastasis in patients with SM > 501 μm of invasion. There were no cases of metastasis in patients without risk factors. ESD might be indicated for lesions within SM 500μm of invasion without risk factors. Among DMM cases of BC, lymphovascular involvement was highly frequent. Therefore, histopathological surveillance for lymphovascular involvement is important.

Disclosure
All authors have declared no conflicts of interest.
RA09.04: THE LYMPH NODE STATUS OF PT1 ESOPHAGOGASTRIC JUNCTIONAL ADENOCARCINOMA
Authors: Mayanagi Shuhei , Kawakubo Hirofumi , Suda Koichi , Kitagawa Yuko 
Published: September 2018

Abstract

Background
There is no consensus regarding the optimal extent of lymphadenectomy for the esophagogastric junctional (EGJ) cancer. The Japanese esophagogastric cancer treatment guideline showed the tentative standard in the extent of lymphadenectomy based on the location, histology and T-categories. The purpose of this study is to identify the lymph node status in patients with pT1 EGJ adenocarcinoma.

Methods
From January 2000 to November 2016, we underwent radical resection with or without sentinel lymph node (SN) mapping for esophagogastric cancer at Keio University Hospital. We identified 38 patients with pT1 adenocarcinoma with its center located within 2cm of the junction. We then analyzed the lymph node status and SN distribution.

Results
The primary tumor that had their epicenter within the proximal of the cardia in 37%, that had their epicenter within the distal of the cardia in 63% of all patients (n = 12, 26). The surgical procedures were proximal gastrectomy (n = 30); subtotal esophagectomy (n = 4); and total gastrectomy(n = 4). Two patients (5%) had positive lymph node metastasis. Of the 2 patients with positive node, one patient had the metastatic lymph node along the short gastric vessels and the other patient had the metastatic lymph nodes along both the left gastric artery and the celiac artery. Those 2 patients with positive node had no recurrence. However, liver or local (anastomotic) recurrence occurred in 1 patients, respectively. SN was accomplished in all patients who underwent SN mapping and diagnostic accuracy based on the SN status was 100% (17/17).

Conclusion
Our results suggested that lower mediastinal lymphadenectomy was of limited significance in patients with pT1 EGJ adenocarcinoma. SN mapping may be contributory to the optimal extent of lymphadenectomy.

Disclosure
All authors have declared no conflicts of interest.