bluuebunny/crossref_metadata_2025_split huggingface dataset:
311. H ANASTOMOSIS FOR LOW INCIDENCE OF ANASTOMOTIC LEAKAGE, OBSTRUCTION AND GASTROESOPHAGEAL REFLUX
Authors: Hu Yang , Wu Na , Xia Qi 
Published: August 2023

Abstract

Background
End to end intussusception anastomosis is associated with reduced anastomotic leakage for the two layers located at different levels and decreased reflux tends for the intussuscepted structures functioning as a morphological sphincter. Nevertheless, dysphagia often presents due to the anatomy that the inner layer of stomach is larger than its outer layer causing bulge to compress the esophagus below, especially at the sight which gastric wall bends inside.

Methods
Here we present procedures to perform H Anastomosis which derives from end to end intussusception anastomosis. The critical improvement was the intussuscepted tissue was transformed from the whole layers of esophagus and stomach to the muscular layers of them. The detailed process was shown in the supplementary video which is available at https://1drv.ms/v/s!AmCqlJJZqDPDgzVKV9w4VPd_i72G?e = ubNzUN.

Results
With removing the intussuscepted seromuscular layer of stomach and muscular layer of esophagus, H anastomosis eliminates the bulge and reduces the thickness of gastric wall covering the esophagus. Postoperative dysphagia is reduced while advantages of intussusception for leakage and reflux control are preserved. These conclusions have been testified by an unpublished prospective cohort study.

Conclusion
H anastomosis is a novel gastroesophageal anastomosis technique. The preliminary study showed good postoperative outcomes regarding leakage, obstruction and gastroesophageal reflux. Further validation is needed.
313. EXPERIENCE OF 4 CASES TREATED WITH IPI + NIVO FOR RECURRENT ADVANCED ESOPHAGEAL CANCER
Authors: Miyagaki Hiromichi , Nishida Kentaro , Yoshikawa Yukihiro , Mori Souichiro , Nomura Masatoshi , Sueda Toshinori , Koga Chikato , Tei Mitsuyoshi , Tsujie Masanori , Akamaru Yusuke 
Published: August 2023

Abstract

Background
The results of the Checkmate 648 trial have made nivolumab plus ipilimumab available in general practice as first-line treatment for advanced recurrent esophageal squamous cell carcinoma.
Unlike regimens that include chemotherapy, this regimen can be used in patients with renal dysfunction, and the Department’s policy is to use this regimen in elderly or renally impaired patients.
We report four patients with advanced or recurrent esophageal cancer treated with nivolumab plus ipilimumab by March 2023.

Patients
Reasons for selecting this regimen; renal dysfunction (4 cases), Disease stage II/IV/recurrent: 1/1/2 patients. Course of treatment: ≤2/≥3 courses: 2/2 pts, 2nd line treatment; FOLFOX for 2 patients, FOLFOX + RT for 1 patient, none for 1 patient.
Nivolumab(administered intravenously at a dose of 360 mg per body every3weeks) plus Ipilimumab(administered intravenously at a dose of 1 mg per kilogram every 6 week) were administrated to four patients.
Adverse events: liver dysfunction in 2 patients, interstitial pneumonia in 2 patients, adrenal insufficiency in 1 patient, rheumatoid arthritis in 1 patient, thyroid dysfunction in 1 patient. Best response: PR for 2, PD for 1, NE for 1 patient.
Patient 1: 86-year-old male, mid-thoracic esophageal cancer T3N0M0 Stage II. After 2 weeks administrated IPI + NIVO, elevations of serum liver enzymes were observed and irAE hepatitis was diagnosed by liver biopsy.
Patient 4: 60-year-old woman, lower thoracic esophageal cancer, T3N2M1 (LYM) Stage IVb. After 2 courses of IPI + NIVO, she developed general malaise and headache, she was diagnosed as irAE adrenal insufficiency and started corticosteroid administration. After the fourth course, a CT scan of the chest showed a frosted glass shadow in the left upper lobe of the lung, irAE interstitial pneumonia was developed, additionally. Steroid pulse therapy was started, and the treatment was switched to FOLFOX therapy.

Conclusion
The response rate was 50%, so the treatment was seemed promising, but irAEs were observed in many patients especially with hepatitis and interstitial pneumonia, and these adverse effect forced patient difficult to continue the treatment. We should be managed to accumulate more patients to evaluate occurrence of irAE.
317. A NOVEL TECHNIQUE OF ‘SUPERCHARGED ELONGATED GASTRIC TUBE’ FOR THE MANAGEMENT OF CORROSIVE PHARYNGEAL STRICTURE
Authors: Dolma Tenzin 
Published: August 2023

Abstract
Oesophageal reconstruction using various visceral conduits is the preferred treatment for the management of dysphagia secondary to corrosive oesophageal strictures. In patients with isolated oesophageal stricture colon and stomach are the most commonly used visceral conduits. However, management of patients with long oesophageal strictures with proximal extent at the hypopharynx is even more complicated. A long replacement conduit is required and most are managed by colopharyngoplasty. The options in patients who lack an available functional colon for esophageal replacement are very limited and may include a combination of gastric pullup with interposition free jejuna or myocutaneous flaps. These operations are complex and often require a two-stage approach. We herein describe a novel single stage approach of using ‘supercharged elongated gastric tube’ for esophageal replacement in a patient with unavailable colon.
325. CAMRELIZUMAB IN COMBINATION WITH CHEMOTHERAPY VERSUS CHEMORADIOTHERAPY FOR THE CONVERSION OF UNRESECTABLE ESOPHAGEAL CARCINOMA: A PROSPECTIVE CLINICAL STUDY PROTOCOL
Authors: Chen Maohui , Zheng Bin , Huang Yizhou , Zhang Shuliang , Zeng Taidui , Ning Chenhui , Chen Chun 
Published: August 2023

Abstract

Background
Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard of care for locally advanced esophageal squamous cell carcinoma (ESCC). However, approximately 30% of patients still develop distant metastases and have a high incidence of treatment-related adverse events. Immunotherapy, as a new modality for anti-cancer treatment, has shown promising clinical benefits for patients with ESCC. The synergistic effects of immunotherapy and radiotherapy make their combination promising as neoadjuvant treatment for locally advanced ESCC.

Methods
All participants who meet the inclusion criteria will be enrolled after signing the informed consent form. Patients with thoracic segment esophageal cancer with clinical stage T2–3 N0 M0 or T2–3 N+ M0 will be included. They will be treated with radical surgery within 4–8 weeks after the completion of two cycles of neoadjuvant radiotherapy in combination with camrelizumab according to the study schedule. The primary endpoint is the major pathological remission rate of all per-protocol patients. The secondary endpoints are the R0 resection rate, pathological complete remission rate, and adverse events. The interim analysis will be conducted after half of the planned number of patients have been enrolled. The trials will be terminated when more than two treatment-related deaths occur or fewer than five patients have major pathological remission.

Discussion
We designed this prospective single-arm phase II clinical study to evaluate the combination of camrelizumab and standard radiotherapy as preoperative neoadjuvant therapy for patients with resectable ESCC as part of the quest for better treatment options for patients with locally advanced ESCC.
Trial registration: This trial protocol has been registered on NIH Clinical Trials database (www.clinicaltrials.gov/, NCT05176002). The posted information will be updated as needed to reflect protocol amendments and study progress.
327. ANALYSING THE ROLE OF PET-CT IN ESOPHAGEAL CANCER: A SINGLE CENTRE COHORT STUDY
Authors: O'Neill Susan , Elliott Jessie , Fahey Niall , Mohan Helen , Carroll Paul , Muldoon Cian , Johnston Ciarán , Donohoe Claire , Ravi Narayanasamy , Reynolds John 
Published: August 2023

Abstract

Background
While PET-CT is considered the gold standard imaging investigation in diagnosing esophageal cancer, its role in determining management is controversial. It demonstrates increased sensitivity for detection of occult M1 disease in comparison with endosonography or CT alone, however its accuracy in assessment of histopathologic response to neoadjuvant therapy is unclear. The aim of this study was to evaluate the clinical utility of PET-CT in staging, response evaluation and prognostication in esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC).

Methods
Patients with esophageal cancer undergoing treatment with curative intent were studied prospectively. Baseline imaging (PET1) was carried out at diagnosis. Repeat scanning (PET2) was performed at 4 weeks post-completion of neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). Pathological complete response (pCR) was defined as TRG1, ypN0. Major pathologic response was defined as TRG1–2, ypN0. Metabolic complete response (mCR) was defined as absence of abnormal FDG uptake at the primary site, nodal sites or suspected metastatic sites. The association between 18F-FDG-uptake (SUVmax) and PET-predicted nodal status, histopathologic parameters and survival were determined using univariable and multivariable regression models.

Results
730 patients were studied. PET identified CT-occult M1 disease in 2.9% and synchronous neoplasms in 1.4%. The relative reduction in SUVmax was greater among patients treated with nCRT compared with nCT (P = 0.021). SUVmax correlated with pT stage among patients treated with primary surgery (P &lt; 0.001), however 32.3% with AC and 15.8% with SCC who were predicted node negative were pN+. Post neoadjuvant therapy, PET parameters showed modest associations with mCR, but no parameter accurately predicted pCR. Among patients with mCR, 90.9% with AC post-nCT, 84.1% with AC post-nCRT and 54.8% with SCC post-nCRT had residual disease. Lower preoperative SUVmax was independently associated with improved survival in AC, but not SCC.

Conclusion
PET-CT identifies CT-occult M1 disease or synchronous neoplasms in 4.3% at initial staging. PET-CT poorly predicts ypN status, particularly in AC. After neoadjuvant therapy, PET-CT is poorly predictive of histopathologic response—the majority of patients with an mCR have residual disease. Nonetheless, improvements in SUVmax may reflect a greater chance of achieving major pathologic response and more favourable long-term outcomes in AC.
328. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL CARCINOMA INVOLVING THE ENTIRE ESOPHAGUS: SHORT-TERM RESULTS
Authors: Toshiro Iizuka , Noma Eriko , Moriguchi Yoshiaki 
Published: August 2023

Abstract

Background
The treatment of superficial esophageal carcinoma involving the entire esophagus remains challenging due to the difficulty in accurate preoperative diagnosis and the complexity of the Endoscopic Submucosal Dissection (ESD) technique. The management of esophageal stricture following ESD also remains controversial. In this study, we analyzed the advantages and disadvantages of ESD for superficial whole circumferential esophageal carcinoma in our hospital, based on short-term results.

Methods
We retrospectively analyzed 10 patients diagnosed with superficial esophageal carcinoma involving the entire circumference and treated with ESD from January 2021 to the present. We evaluated the accuracy of preoperative diagnosis, treatment-related complications of ESD, post-ESD stenosis, and adverse events associated with stenosis prophylaxis.
Treatment Course: The primary treatment consisted of circumferential resection under general anesthesia followed by local injection of 120–320 mg of steroids into the ulcer after resection. Patients were started on a diet 2–3 days after surgery and initiated oral steroid therapy starting with 30 mg with PPI and Sulfamethoxazole Trimethoprim. The dose of steroids was gradually reduced by 5 mg every 3 weeks for a total of 18 weeks.

Results
The study included 7 males and 3 females with a mean age of 72.9 years. The lesions were located in Upper 1, Middle 5, and Lower 4. The average dissection time was 89.1 minutes, the mean length of endoscopic longitudinal mucosal defects was 70 mm, and the en bloc resection rate was 100%. The histological depth was EP/LPM 5, MM/SM 13, and SM2 or deeper 2. The accuracy of preoperative diagnosis was 80%, but all SM2 lesions were underdiagnosed as SM1. No ESD-related adverse events were observed in any case. Two patients with SM2 after ESD underwent additional surgery. Stenosis occurred in 25% of cases. Steroid-related events included drug-induced liver dysfunction in 4 cases, esophageal candida in 2 cases, pulmonary tuberculosis in 1 case, and delayed perforation in 1 case.

Conclusion
ESD for superficial esophageal carcinoma involving the entire esophagus can be safely and effectively performed. Steroid administration may be useful for preventing post-ESD stenosis, but its management requires attention as it may cause adverse events.
330. PRE-EMPTIVE ENDOLUMINAL VACUUM THERAPY WITH A SURGICAL DRAIN FOR REDUCTION OF ANASTOMOTIC LEAK RATE FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Sivarajan Sri , Kulasegaran Suheelan , Penney Nicholas , Ari Kaso , Kumar Bhaskar , Sreedharan Loveena 
Published: August 2023

Abstract

Background
Endoluminal vacuum therapy (EVT) is an effective treatment for anastomotic leak (AL) following esophagectomy. A novel application of EVT is to utilise its effect to improve microcirculation and granulation at the anastomosis pre-emptively to reduce the risk of AL. We describe a unique method of positioning a fenestrated surgical drain with applied vacuum suction at the level of the anastomosis following minimally invasive esophagectomy (MIE), with the aim of reducing AL rate and postoperative morbidity.

Methods
A retrospective cohort comparison was performed on consecutive MIEs from 2019 to 2023. All operations were performed by experienced esophagogastric surgeons at a tertiary centre in the UK. Included patients were all adults undergoing MIE for esophageal cancer. Patients who underwent pre-emptive EVT (pEVT) with surgical drain following MIE were compared with a control group who underwent MIE alone. All patients followed the same enhanced recovery protocol with pEVT removed two to five days post-operatively. The primary outcome assessed was AL, secondary outcomes included: length of stay (LOS), readmission to Intensive care, complications (Clavien-Dindo) and 90-day mortality with minimum 90-days follow-up.

Results
72 patients were included, 25 patients underwent MIE with pEVT compared with 47 in the control. The AL rate in the pEVT group was 8% compared with 21.3% in the control (RRR 62%, p = 0.13). All ALs following pEVT were managed successfully with EVT alone. There was a reduced risk of aspiration pneumonia (RR:0.37, p = 0.22) and readmission to ICU (RR:0.24, p = 0.049) following pEVT. There was 0%, 90-day mortality in both groups and no significant difference in median LOS (7 vs 9 days, p = 0.72 (pEVT vs Control)). However, a higher risk of stricturing following pEVT was noted (RR:3.76, p = 0.04).

Conclusion
Our data suggests pEVT with a surgical drain may be a safe and effective method of reducing AL rate following MIE. Additionally, it confers the benefit of being an effective treatment for AL should this complication arise. There was significant increase in benign stricturing requiring dilatation following pEVT, however, this may be attributable to other operative factors. Our results support the need for further prospective studies such as a randomised controlled trial.
341. THE PREDICTION STRATEGY OF SUBMUCOSAL INVASION IN SUPERFICIAL BARRETT’S ADENOCARCINOMA BY THE COMBINATION OF HISTOLOGY IN BIOPSY AND MAGNIFYING ENDOSCOPY
Authors: Namikawa Ken , Fujisaki Junko , Kawachi Hiroshi 
Published: August 2023

Abstract

Background
Endoscopically predicting the depth of invasion of superficial Barrett’s esophageal adenocarcinoma (s-BEA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics to diagnose s-BEA with submucosal invasion.

Methods
We retrospectively reviewed 105 tumors from 97 patients endoscopically and pathologically diagnosed with s-BEA in short-segment Barrett’s esophagus (SSBE) (60 lesions in 60 patients) and long-segment Barrett’s esophagus (LSBE) (45 lesions in 37 patients). One hundred five s-BEA lesions were classified into 60 intramucosal (pT1a) tumors and 45 submucosal (pT1b) tumors. Clinicopathological and endoscopic characteristics, including the histology in the biopsy specimens, were analyzed with comparison in pT1a vs pT1b tumors. The histology in the biopsy specimens was classified into two types such as the presence or absence of poorly differentiated component (PDC). Risk factors for submucosal invasion identified using univariate analysis were entered into a multivariate logistic regression analysis. Subsequently, the findings of magnifying endoscopy with narrow-band imaging (ME-NBI) were assessed to determine whether the poorly differentiated component (PDC) in the resected specimens can be identified or not.

Results
pT1b tumors showed significantly higher frequency than pT1a tumors in the following features: PDC in the biopsy specimens (21/45, 46.7%; vs 1/60, 1.7%; OR = 24.8), complex macroscopic type (33/45, 73.3%; vs 15/60, 25.0%; OR = 4.47), and tumor diameter &gt; 20 mm (31/45, 68.9%; vs 13/60, 21.7%; OR = 4.40). In 87 tumors which were able to be evaluated for endoscopic findings with ME-NBI, 9 out of 11 tumors with corkscrew pattern or wavy micro-vessels showed PDC in the resected specimens. The sensitivity, specificity, and positive predicted value of these irregular vessels for predicting PDC in the resected specimens were 40.9%, 96.9%, and 81.8%, respectively.

Conclusion
PDC in the biopsy specimens, tumor diameter &gt; 20 mm, and complex macroscopic type were independent predictors for submucosal invasion of BEA. The presence of PDC in the biopsy specimens was an especially useful predictor of T1b cancer with the highest odds. Further, ME-NBI can be useful to diagnose the presence of PDC in BEA.
350. FUNCTIONAL RESPONSES OF SWINE ESOPHAGUS TO FOCAL CRYOTHERAPY
Authors: Upchurch Weston , Iaizzo Paul 
Published: August 2023

Abstract
Barrett’s esophagus is a premalignant condition where the squamous epithelium of the distal esophagus is replaced by columnar epithelium. Treatment involves endoscopic resection followed by ablation for complete eradication. Various ablative techniques exist including cryotherapy which utilizes a cryogen spray or balloon catheter. While efficacious, complications such as dysphagia have been reported. To better understand the underlying mechanism of how cryotherapy might damage the muscularis, isolated muscle strips were ablated and their function studied.
Isolated muscle strips with the mucosa layers removed were prepared from freshly isolated swine esophagus and placed in tissue baths where they were electrically stimulated, and contractile forces were recorded. Contractile responses were allowed to stabilize before a given muscle strip was removed for focal ablation. Cryoablation was performed with a focal cardiac ablation catheter (Freezor, Medtronic). Following ablation, the given muscle strip was returned to the tissue baths. Regression analyses were performed using temperature data from a thermocouple integrated into the tip of the ablation catheter and contractile forces after the esophageal muscle strips had recovered for 3 hours.
Ablations lasting less than 60 seconds were applied to 135 esophageal muscle strips: with an average mass of 94 mg. From the experimental data, a multiple linear regression model was generated: 71.93 + 0.4770x—0.5530y = z, where x is the minimum temperature (C), y is the time below 0 C, and z is the contractile force (normalized to preablative force, %). Our model has an adjusted R-squared value of 0.508. As expected, lower minimum temperatures and longer treatment times were associated with greater losses in stimulated muscle forces.
We were able to reproducible ablate isolated swine esophageal strips that elicited contractile responses in vitro. Lower temperatures and longer treatment times were associated with greater losses in stimulated muscle forces. Yet, the adjusted R-squared value indicates that temperature and time only partially explain the response. Future studies could be improved by accounting for variabilities in sample sizes and additionally, regression diagnostics need to be performed to check for outliers and validate model assumptions.
358. CIRCULAR STAPLER METHOD FOR AVOIDING STRICTURE OF CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS, ‘NON-TENSIONING METHOD’
Authors: Shiraishi Osamu , Terada Masuhiro , Koda Masashi , Nakanishi Tomoya , Hagi Takaomi , Hiraki Yoko , Kato Hiroaki , Yasda Atsushi , Shinkai Masayuki , Imano Motohiro , Yasuda Takushi 
Published: August 2023

Abstract

Background
The weakness for the circular stapler technique of esophagogastric anastomosis for esophageal cancer is anastomotic stricture. This study was performed to verify the superiority of a new ‘non-tensioning method’ for avoiding stricture of the cervical esophagogastric anastomosis by circular stapling compared with the conventional method.

Methods
In 461 patients who underwent McKeown esophagectomy with gastric conduit (GC) reconstruction were reviewed. A GC was pulled up at the cervical site through the retrosternal route. The esophagogastrostomy site of the GC was planned as far caudally as possible on the greater curvature side. In the conventional method, the stapler was fired while pulling the GC to avoid tissue slack. In the new method, the stapler was fired through the natural thickness of the stomach wall. The blind end length was changed from 4 to 2 cm. Anastomotic stricture was compared between the two techniques, and adjustment was performed using propensity score matching.

Results
The conventional group comprised 315 patients, and the non-tensioning group comprised 146 patients. Anastomotic leakage occurred in 22 (7%) and 6 (4%) patients, respectively (P = 0.211) [and in 9 (3%) and 3 (2%) patients, respectively, if leakage at the blind end was excluded]. Anastomotic stricture occurred in 92 (29%) and 7 (5%) patients, respectively (P &lt; 0.001). The propensity score-matching analysis including 134 pairs of patients confirmed a lower stricture rate in the non-tensioning than conventional group (4% vs. 27%, P &lt; 0.001).

Conclusions
The non-tensioning technique, the natural thickness of the stomach wall was fired with the stapler, significantly reduced the incidence of anastomotic stricture compared with the conventional technique.