bluuebunny/crossref_metadata_2025_split huggingface dataset:
47. PERORAL ENDOSCOPIC MYOTOMY VS HELLER MYOTOMY WITH FUNDOPLICATION IN OUR CENTER
Authors: Muranami Yuto , Sato Chiaki , Taniyama Yusuke , Okamoto Hiroshi , Ozawa Yohei , Ishida Hirotaka , Koseki Ken , Kanabuchi Sawa , Fusegawa Kazuki , Kamei Takashi 
Published: August 2023

Abstract
Heller myotomy with fundoplication (HF) is one of the established treatments for esophageal achalasia. However, the less invasive Peroral endoscopic myotomy (POEM) is rapidly spreading. Several papers report short-term efficacy and safety of POEM is as well as HF, but GERD is more frequent after POEM. Moreover, the long-term outcome is still unknown.
This is a single center retrospective study. In our center, HF was carried out for 59 patients between 1999 and 2014. Among them, 58 cases underwent laparoscopic procedure, 52 were with Dor fundoplication and 7 were with Toupet. From 2015 we performed POEM for 224 patients until Dec 2022.
For POEM, grade of dilatation was lower (I/II/III=POEM;76/131/17, HF;6/44/9, p &lt; 0.001) and esophageal myotomy length was longer (8.5 ± 3.4 cm vs 5.7 ± 0.8 cm, P &lt; 0.001). Median IRP and Eckardt score decreased for them (24.3 ± 13.0 to 7.8 ± 4.8 mmHg/5.37 ± 2.09 to 0.54 ± 0.84). HF improved their LES pressure (40.2 ± 20.3 to 18.0 ± 7.1 mmHg, p &lt; 0.001). Postoperative LA grade B GERD was more often for POEM (26.9% vs 4.7%, p &lt; 0.001), however grade C or D were comparable. All of them were controlled by PPIs, except one POEM patient considering further treatment. For HF, median follow-up period was longer (78 vs 19 mo), however, additional treatment was more necessary (6.8% vs 1.3%, p = 0.033).
Postoperative grade B GERD was more common for POEM, but almost all of them were controlled by PPIs. POEM was less likely to require additional treatment, though follow-up time was relatively short. Further observation and re-evaluation are warranted.
135. IMPACT OF GENDER, RACE AND AGE OF ONSET ON THE PHENOTYPE AND COMORBIDITIES OF PEDIATRIC EOSINOPHILIC ESOPHAGITIS
Authors: Mckeown Kyle , Pritchett Justin , Carlisle Annette , Lieberman Jay , Xi Dong 
Published: August 2023

Abstract
Eosinophilic esophagitis (EoE) is recognized as chronic immunologic disorder of the esophagus resulting in esophageal inflammation by the accumulation of eosinophils in the epithelium. Several risk factors are thought to be associated with the development of EoE, but because of its complex underlying mechanisms of disease, there is little clarity in regards to the different symptoms experienced, pathological findings and associated comorbidities including atopic and allergic disorders between different gender, race and age of onset.
This study utilized a retrospective chart review on the patients seen by a multidisciplinary EoE clinic from January 2020 to December 2022. Subjects were diagnosed with EoE, and retrospectively assessed for eosinophilic counts on the initial distal and proximal esophageal biopsies, and previously specified symptoms and comorbidities. The differences of eosinophilic counts, associated symptoms and comorbidities between gender (male or female), race (White or non-White) and age of onset (≤ 6 years old is defined as early onset, or &gt; 6 years old is defined as regular onset in this study), were statistically analyzed by t-test or Chi-Square. P &lt; 0.05 is considered as significant.
Ninety patients were included in this study, of whom 72% are male (M) while 28% are female (F), and 68% are White (W) while 32% are non-White (NW). Age of onset ranges from 1 year to 17 years, with 44% being early onset while 56% being regular onset. We found females and White race were significantly more likely to report dysphagia. Non-White patients were found to have higher incidence of vomiting, asthma than White. Significant higher incidence of vomiting, and eosinophilic counts was found in early onset (EO) patients (distal: 56, proximal: 50) compared to regular onset (RO) (distal: 39, proximal: 39), while no significant difference was found between different gender and race.
Our retrospective study demonstrated that there are significant differences between different gender, race and age of onset for pediatric EoE in regard to the severity of eosinophilic inflammation, gastrointestinal symptoms and associated comorbidities. These findings could provide some guidance to clinicians in identifying proper diagnosis and developing appropriate treatment to achieve the best outcome.
150. PATTERN OF LYMPH NODE RECURRENCE AFTER NEOADJUVANT CHEMORADIOTHERAPY AND MODIFIED EN BLOC ESOPHAGECTOMY
Authors: Hsu Po-kuei 
Published: August 2023

Abstract

Background
Esophageal cancer is an aggressive malignancy with high incidence of lymph node metastasis and recurrence rate even after neoadjuvant treatment and radical resection. Previous study has shown that modified en bloc esophagectomy (mEBE) improves survival for esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT). In this study, we aim to investigate the pattern of lymph node recurrence after nCRT+mEBE.

Methods
The data of patients who received nCRT followed by curative surgical resection for ESCC were retrospectively reviewed. The mEBE includes ‘mesophagus’ dissection and bilateral recurrent laryngeal nerve node dissection, whereas conventional esophagectomy (CE) only requires periesophageal tissues dissection that were close to the esophagus. The pattern of recurrence, especially lymph node recurrence (cervical, upper mediastinum, infra-carina, and abdominal), were compared between CE and mEBE, with stratification according to pathological stage (ypT0N0 or not.)

Results
A total of 221 (CE, n = 181; mEBE, n = 40) patients were included. Mediastinal lymph node recurrence was noted in 16.0% and 7.5% of patients after CE and mEBE, respectively (p = 0.166). In ypT0N0 patients who received CE, 6.0% had upper mediastinum recurrence, whereas no mediastinal recurrence was noted after mEBE (p = 0.329). In non-ypT0N0 stage patients who received CE, 15.3% and 8.2% had upper mediastinum and infra-carina recurrences, compared to 12.0% and 0% after mEBE (p = 0.283). There cervical/abdominal recurrences were noted in 6.6%/7.2% and 15.0%/5.0% after CE and mEBE, respectively (p = 0.080/0.618).

Conclusion
Although there was no significant difference in lymph node recurrence pattern between mEBE and CE, we observed that (1) 6% of ypT0N0 patients developed mediastinal lymph node recurrence after CE, implying the possibility of understaging after CE; (2) no patients developed infra-carina lymph node recurrence after mEBE, suggesting the necessity of mesoesophagus dissection, and (3) high incidence of cervical lymph node recurrence even after mEBE, indicating that cervical dissection should be considered in selected patients.
152. SINTILIMAB PLUS CISPLATIN AND PACLITAXEL INDUCTION TREATMENT FOR BORDERLINE RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PHASE II CLINICAL TRIAL
Authors: Wu Jia-Di , Wang Zhi-Qiang , Zhao Ze-Rui , Li Qiao-Qiao , Wu Jia-Di , Li Zhi-Chao , Li Yu-Hong 
Published: August 2023

Abstract

Background
An increasing number of clinical studies focus on investigating the use of immunotherapy in the treatment of esophageal cancer. This phase II trial (NEOCRTEC-2001 clinical trial) aimed to assess the safety and efficacy of sintilimab in combination with cisplatin and paclitaxel induction immunochemotherapy followed by surgery for locally advanced borderline-resectable esophageal squamous cell carcinoma (BR-ESCC).

Methods
Patients with primary tumor or bulky lymph nodes that might invade nearby organs were eligible. Treatment started with 2–4 cycles of induction immunochemotherapy, followed by surgery if the tumor was assessed resectable, or by radical concurrent chemoradiotherapy if unresectable. The primary endpoint was pathologically proven complete resection (R0) rate. The secondary end points included pathological complete response (pCR) rate, overall survival (OS), progression-free survival (PFS), adverse events and postoperative complication.

Results
From September 2020 to now, a total of 34 patients were enrolled. After immunochemotherapy, 21 patients (61.8%) received surgery and 13 (38.2%) did not. All patients underwent McKeown procedure, and median operation time was 295 minutes (range 201–489 minutes). All patients received esophageal reconstruction using gastric tube, and underwent cervical anastomosis. An average of 46.6 lymph nodes were dissected, and positive lymph nodes were observed in 5 of the 21 patients. R0 resection was confirmed in 20 patients (58.8%). One patient underwent R2 resection because of tumor invasion of the aorta. Pathologic complete response was confirmed in 6 patients (6/34, 17.6%), while 5 patients (5/34, 14.7%) had few or no regressive changes (TRG3).

Conclusion
The treatment strategy of induction immunochemotherapy followed by surgery is promising for patients with locally advanced borderline-resectable esophageal squamous cell carcinoma. The whole results of pathologic response and prognostic value are awaited with interest.
177. BULKY LYMPHADENOPATHY IN ESOPHAGEAL CANCER: ASSESSING PATHOLOGICAL AND SURVIVAL OUTCOMES AFTER TREATMENT WITH CURATIVE INTENT
Authors: Tankel James , Nevo Yenothan , Najmeh Sara , Spicer Jonathan , Mueller Carmen , Ferri Lorenzo , Cools-Lartigue Jonathan 
Published: August 2023

Abstract

Aim
Whilst pre-treatment bulky regional lymphadenopathy is associated with poor survival outcomes in gastric adenocarcinoma, the impact this may have on survival in the setting of esophageal adenocarcinoma has not been described. The aim of this study was to explore the relationship between bulky regional lymphadenopathy found at diagnosis and survival outcomes in patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy and en bloc esophagogastrectomy.

Methods
A single center, retrospective review of a prospectively maintained upper GI cancer surgical database was performed between 01/2012 and 12/2020. Patients with adenocarcinoma of the esophagus/esophagogastric junction (cT2–3, Nany, M0) treated with neoadjuvant docetaxel based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Pretreatment CT scans were reviewed and patients stratified according to whether bulky periesophageal or periceliac lymph nodes were present. This was defined as periceliac or periesophageal lymphadenopathy &gt;2 cm in its long axis. Once stratified by the presence of bulky lymphadenopathy, overall survival (OS) was compared and a Cox multivariate regression model calculated.

Results
Of the 975 patients identified, 225 met the inclusion criteria. cT3/4 and cN+ was found in 169/225 (75%) and 154/225 (73%) respectively. Forty-eight patients (21%) were allocated to the bulky lymphadenopathy group. Among them, ypT status was similar, ypN3 disease more common (18/48,38% vs 39/177,20%, p = 0.025) with a trend towards pathological complete response (5/48,10% vs 7/177,4%, p = 0.086). OS was worse among patients with bulky regional lymphadenopathy (32.6 vs 50 months, p = 0.012). Along with poor differentiation (HR 1.8,95% CI 1.0–2.9, p = 0.034) and ypN+ (HR 1.9,95% CI 1.1–3.6, p = 0.032), bulky lymphadenopathy was independently associated with an increased risk of death (HR 1.7,1.0–2.9,p = 0.048).

Conclusion
Pre-treatment bulky regional lymphadenopathy is a poor prognostic sign despite multimodal treatment with docetaxel based systemic neoadjuvant therapy and en bloc resection. Identification of alternative treatment strategies may help improve survival outcomes among this specific group of patients.
184. INTRATHORACIC SIDE-OVERLAP ESOPHAGOGASTROSTOMY DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Shoji Yoshiaki , Koyanagi Kazuo , Kanamori Kohei , Tajima Kohei , Ogimi Mika , Ninomiya Yamato , Yamamoto Miho , Kazuno Akihito , Nabeshima Kazuhito , Nishi Takayuki , Mori Masaki 
Published: August 2023

Abstract

Backgrounds
Surgical algorithm for esophagogastric junction cancer have been proposed according to the results of a recent prospective study. However, reconstruction method has yet to be standardized. Esophagogastrostomy is often performed for esophagogastric junction cancer with esophageal invasion, although, it has been related to frequent and severe complications. Recently, we have introduced IntraThoracic Side-overlap EsophagoGastrostomy (ITS-EG), an eazy and novel intrathoracic anastomotic method with reflux prevention mechanism during minimally invasive esophagectomy for esophagogastric junction cancer.

Methods
We retrospectively reviewed patient backgrounds and surgical/short term outcomes for the patient who underwent ITS-EG during minimally invasive esophagectomy for esophagogastric junction cancer between February 2018 to April 2023 at our institute.

Results
The study cohort included ten patients, with a median age of 67 (55–77) years. All tumors were classified as Siewert type II, and the median esophageal invasion length was 32 (11.8–40) cm. After extended proximal gastrectomy, patients underwent either thoracoscopic (five patients) or robot-assisted (five patients) minimally invasive esophagectomy followed by ITS-EG. ITS-EG consist of overlap anastomosis utilizing surgical stapler, and reflux prevention mechanism owing to the creation of pseudo-fornix and a slit-shaped anastomosis. The initial case suffered anastomotic leakage, however, recovered by conservative measures. All the other patients had an uneventful recovery without reflux esophagitis nor anastomotic stricture.

Conclusion
ITS-EG is an easy and safe esophagogastric anastomosis with reflux prevention mechanism during minimally invasive esophagectomy, and may be considered for esophagogastric junction cancers with esophageal invasion. Further accumulation of cases is needed to demonstrate the safety and efficacy of ITS-EG. Surgical procedure for ITS-EG would be presented by video.
191. CIRCULATING TUMOR DNA (CTDNA) ANALYSIS FOR DETECTION OF RESIDUAL DISEASE AFTER NEOADJUVANT CHEMORADIOTHERAPY (NCRT) FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC)
Authors: Liu Zhichao , Yang Yang , Liu Jun , Fu Xiaolong , Chen Songan , Li Xi , Xiang Jianxing , Zhu Mingjun , Li Zhigang 
Published: August 2023

Abstract

Background
High pathological complete response (pCR) rates were observed in ESCC patients after nCRT. A ‘Watch and Wait’ strategy has been proposed for patients with clinical complete response (cCR) after nCRT. However, clinical assessments (e.g. endoscopic biopsy) may misclassify non-pCR as cCR. In this study, we investigate the value of two kinds of ctDNA analysis strategies in predicting tumor response and residual disease after nCRT in ESCC, including personalized panel and tumor-naïve fixed panel (TNFP) analyses.

Methods
This is a side study of preSINO trial (NCT03937362). After nCRT completion, patients underwent clinical response evaluations (CREs) before planned surgery. CRE-1 was 4–6 weeks after nCRT. CRE-2 was 10–12 weeks after nCRT for patients without histological evidence of residual tumor at CRE-1. Individual tumors and matched white blood cells prior to nCRT (B0) were whole-exome sequenced for somatic mutations selection. Serial plasma samples were analyzed by brPROPHET personalized panel and 168-gene TNFP respectively at three timepoints: B0, CRE-1, CRE-2. We correlated ctDNA status with pCR and major locoregional residual disease (MLRD) (&gt;10% residual cancer or any residual nodal disease).

Results
A total of 55 ESCC patients who received per-protocol treatments underwent ctDNA detection. The pCR rate was 27% (15/55). 98.38% of variants selected for brPROPHET panel design were private to a specific patient, only 3.1% of variants were included in the TNFP (Fig. A-B). ctDNA positive rates of brPROPHET were significantly higher than TNFP assay at three timepoints (Fig. C). Importantly, the brPROPHET achieved higher sensitivity than TNFP in predicting non-pCR and MLRD owing to its ability to detect extremely low ctDNA fractions (Fig. D). Moreover, combining brPROPHET with CREs could further improve the sensitivity (Fig. E).

Conclusion
Personalized ctDNA analysis exhibited superior sensitivity and predictive performance than TNFP assay. What’s more, personalized ctDNA analysis can supplement the clinical assessment to decrease the false negative rate in identifying patients with residual disease after nCRT, and might become useful in the ‘Watch and Wait’ strategy for the management of ESCC.
194. INTENSIVE SURVEILLANCE INCREASES SALVAGE SURGERY AND SURVIVAL RATES FOR ESOPHAGEAL CANCER
Authors: Walsh Thomas , Abdulrahman Rand , Abdulrahman Maan , Shamiya Khalid Adnan , Al-Khusaibi Mohamed , Picket Lianne , Monaghan Orla , O’Neill Brian , Grogan Liam , Sorensen Jan 
Published: August 2023

Abstract

Background
Following curative treatment there are no international follow-up guidelines, with most relying on symptoms for reinvestigation. This may delay diagnosis and impair survival. We hypothesized that intense surveillance would detect recurrent disease at a salvageable stage: and this study compared the outcome for patients undergoing salvage surgery for recurrent disease identified on intense surveillance with survival of patients that had undergone curative treatment for locoregionally advanced disease and didn’t require salvage surgery.
Patients and Methods: A prospective database of esophageal carcinoma patients treated with curative intent was interrogated for patients with recurrent or new cancers amenable to salvage surgery. Surveillance consisted of 3-monthly endoscopy and 6-monthly CT scanning for 3 years, 6-monthly endoscopy and yearly CT scanning to 5 years, and endoscopy yearly with imaging as desired thereafter. Once new or recurrence cancer was diagnosed patients were restaged and, if suitable, underwent salvage surgery. Their outcome was compared with patients undergoing chemoradiotherapy plus or minus resection for locoregionally advanced disease.

Results
Of 205 patients treated with curative intent, 24 (11.7%) patients underwent salvage surgery for locoregional, metastatic or second primary tumours. They had a median survival of 48.4 months and a 3-year survival of 54.6%. This compares to 157 patients with locoregionally advanced disease not requiring salvage surgery, who had a median survival of 45.6 months and a 3-year survival of 44%, which was statistically insignificant between the groups (p = 0.975).

Conclusions
In this hypothesis-generating study an intensive surveillance strategy identified a cohort of patients (almost 12%) with recurrence disease or new primary cancers amenable to salvage surgery and with outcomes non-inferior to patients without recurrence. As most were asymptomatic, it is unlikely that curative intervention would have been as successful without surveillance. It is suggested that surveillance guidelines be updated to standardize interval endoscopy/imaging as for other GI malignancies.
197. FIBROSING MEDIASTINITIS CAUSING CONCOMITANT FOCAL STRICTURE AND TRACTION DIVERTICULA OF THE ESOPHAGUS
Authors: Dickerson Austin , Ford Kenneth , Nguyen Anh D 
Published: August 2023

Abstract

Background
Fibrosing mediastinitis, also known as mediastinal fibrosis or sclerosing mediastinitis, is a rare condition caused by an excessive fibrosing reaction of the mediastinum. The clinical presentation of fibrosing mediastinitis varies based on the mediastinal structures involved, which can include the great vessels, airway, thoracic duct, phrenic nerve, or esophagus. We present a unique case of a patient with fibrosing mediastinitis causing dysphagia due to esophageal involvement with both focal esophageal stricture and multiple traction diverticula.
Case Report: 82-year-old man with a past medical history of treated pulmonary tuberculosis in his 20s, Crohn’s colitis and gastroesophageal reflux disease presented to clinic with worsening dysphagia for the past few years with chronic dysphagia symptoms for the past 50 years. Barium esophagram demonstrated a stricture in the upper to mid esophagus and a corkscrew pattern of the mid-esophagus (Figure 1). Esophagogastroduodenoscopy demonstrated an esophageal stricture and multiple traction diverticula distal to the stricture. Computed tomography of the chest showed homogeneous soft tissue encasing the trachea and esophagus consistent with fibrosing mediastinitis. Serial dilation of the esophageal stricture was performed, but mucosal disruption was never achieved with no improvement in stricture diameter. The case was discussed in a multi-disciplinary conference where esophageal stenting was not felt to be feasible given multiple traction diverticula, and esophageal resection would be high risk given the fibrosing mediastinitis. Risks and benefits were discussed with the patient, and the patient opted to do dietary modifications as he did not have dysphagia on a pureed diet.

Discussion
Fibrosing mediastinitis is often idiopathic but can be due to infectious/inflammatory processes, sarcoidosis, or radiation exposure. The most common cause of fibrosing mediastinitis is prior infection with Histoplasma capsulatum. In this case, fibrosing mediastinitis from remote Mycobacterium tuberculosis infection resulted in a focal stricture and traction diverticula of the esophagus causing dysphagia. Barium esophagram revealed a corkscrew pattern of the esophagus, a pattern usually seen in diffuse esophageal spasm but was due to multiple traction diverticula. Fibrosing mediastinitis causing dysphagia is rare, and no prior reports in the literature describe a case causing concomitant esophageal stricture and traction diverticula in a patient.
218. INITIAL EXPERIENCES WITH VACUUM-STENT AS NOVEL TREATMENT OPTION FOR TRANSMURAL DEFECTS IN THE UPPER GASTRO-INTESTINAL TRACT: A SINGLE-CENTER CASE SERIES
Authors: Pattynama Lisanne , Eshuis Wietse J , Bergman Jacques J , Berge Henegouwen Mark I , Pouw Roos 
Published: August 2023

Abstract

Background
Transmural defects in the upper gastro-intestinal (GI) tract (anastomotic leak, Boerhaave syndrome, iatrogenic defects) are associated with severe morbidity. Recently, a vacuum-stent was introduced as novel treatment device, combining the benefits of negative pressure wound therapy and an intraluminal stent, while allowing for oral intake of a soft diet. The aim of this prospective case series was to describe the first experiences with the vacuum-stent for the upper GI tract in an academic hospital.

Methods
All patients treated with a vacuum-stent between March 2022 and March 2023 were included. Patients who were already treated with vacuum-sponge and received a vacuum-stent when it became available were also included. Outcome measures included successful closure of the defect, adverse events, number of EVT-related endoscopies and treatment duration.

Results
23 patients were included (18 male, median age 65 years). Fourteen patients had anastomotic leakage after esophagectomy, five patients an iatrogenic perforation and four had Boerhaave syndrome. Twelve patients were treated with vacuum-stent alone and eleven with a combination of vacuum-stent and vacuum-sponge (Table 1), which was mostly due to the later availability of or limited experience during the implementation period of the vacuum-stent. Success rate was 91%, median 4 (IQR 3–8) EVT-related endoscopies were performed during median 14 (IQR 12–31) days of treatment in successful cases. During median 120 (IQR 15–221) days follow-up, four patients developed an anastomotic stricture treated with endoscopic dilation. No other adverse events were observed.

Conclusion
The vacuum-stent combines the benefits of EVT and an intraluminal stent and shows great feasibility and efficacy in treatment of transmural defects in the upper GI tract. More research is necessary, as this device could possibly prevent major (re-)surgery in these patients.