bluuebunny/crossref_metadata_2025_split huggingface dataset:
567. MDT OPTIMIZATION FOR DIAGNOSTIC WORKUP OF ESOPHAGEAL CANCER
Authors: Van Doesburg Jasmijn , Nilsson Magnus , Lindblad Mats , Gisbertz Suzanne , Luttikhold Joanna , Daams Freek 
Published: September 2022

Abstract
Rapid and complete workup of esophageal cancer is vital for a timely and individual treatment strategy. The aim of this study is to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process.
This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC or Karolinska Institutet between July 2020 and July 2021. Radiology, pathological assessment and MDT meeting reports were reviewed. To assess time interval from diagnosis to treatment, information on date of diagnosis, admittance to referral hospital, MDT and start treatment was collected.
This study included 252 esophageal cancer patients, 187 were treated with curative intent. Curative patients had a median age of 68, were predominantly male (74.9%) with adenocarcinoma (71.4%). Patients had a median of 34 days (IQR:27-43) between diagnosis and start treatment and a median time to referral of 6 days (IQR:0-11). Main denominators for prolonged time between diagnosis and treatment was need for additional diagnostics (45.5%) and local protocol (Amsterdam UMC 39 days vs Karolinska 27 days). However, for 33 out of 77 patients (42.9%), no other than logistical reasons could be found.
Differences in time between diagnosis and treatment in the centers can be explained by variations in workup protocol, MDT regulations and the need for additional diagnostics.
576. ESOPHAGEAL ACHALASIA: VERY LONG FOLLOW-UP STUDY ON PATTERNS AND COMPLICATIONS OF POST MYOTOMY GERD
Authors: Tassi Valentina , Lugaresi Marialuisa , Mattioli Benedetta , Daddi Niccolo' , Pilotti Vladimiro , Mattioli Sandro 
Published: September 2022

Abstract
Since the adoption of the Heller myotomy, surgeons have modified the original technique to balance the cure of dysphagia and the consequent cardial incontinence. Surprisingly, today post POEM 30-50% erosive-ulcerative esophagitis rates are by some put inside normality. Our group had the opportunity to follow up methodically patients submitted to Heller myotomy since 1955. Aim is to provide information on long-term outcomes of Heller myotomy for esophageal achalasia with or without an antireflux fundoplication.
In first instance 83 patients underwent a long abdominal myotomy (AM 1955-72), 30 patients a transthoracic myotomy according to Ellis (TM 1973-78), 364 patients the Heller-Dor operation with intraoperative manometry to calibrate myotomy, length and pressure of the Dor fundoplication (HD 1979-2021). Starting on 1973 these patients underwent a prospective follow-up program of timed lifelong clinical, radiological, endoscopic evaluations. Since 1973 an endoscopic-radiologic-clinical timed follow up has been established. GERD symptoms/esophagitis were evaluated.
AM, TM and HD groups were followed up for a median period of 25, 27, 14 years respectively. GERD symptoms-esophagitis occurred in AM 29.5%-28.1%, TM 30%-30%, HD 6.6%-5.8%. Timing of esophagitis after HD revealed: early onset (6-24 months) in 8 (2.2%), late onset (25 months-14 years) in 13 (3.6%). PPIs controlled reflux symptoms (71%vs14%, p&lt;0.0001) but not esophagitis (43%vs46%, p= 0.075). Among 50 patients with erosive/ulcerative reflux esophagitis, Barrett’s esophagus was diagnosed in 21 (42%) at a median period of 112 months since myotomy. In this group low-grade dysplasia occurred in 12 (24%) and high grade dysplasia/adenocarcinoma in 5 (10%).
After surgical Heller myotomy not associated with an efficient antireflux procedure, GERD occurred in 30% which decreased to 6% after HD. A Heller-Dor operation is a competitive option for the cure of esophageal achalasia if this operation is performed according to the rules of surgical physiology learned by means of intraoperative manometry. The adoption of POEM in alternative to HD for the treatment of achalasia should be questioned.
579. LONG TERM RESULTS OF THE PULL-DOWN HELLER-DOR TECHNIQUE FOR ACHALASIA PATIENTS WITH SIGMOID ESOPHAGUS
Authors: Tassi Valentina , Lugaresi Marialuisa , Daddi Niccolò , Pilotti Vladimiro , Mattioli Benedetta , Bassi Francesco , Mattioli Sandro 
Published: September 2022

Abstract
The outcome of achalasia treatment in patients with sigmoid esophagus is worse than that achieved for fusiform achalasia. We compared two groups of sigmoid achalasia patients, in which we performed the standard Heller-Dor procedure (HD) and the Heller-Dor plus a technique aimed to restore the vertical axis of the intraabdominal portion of the esophagus pull-down Heller-Dor (PD-HD). Long-term results were evaluated.
We considered 48 patients affected by primitive esophageal sigmoid achalasia operated upon consecutively (1979-2021) in first instance. After 1987, we routinely isolated 360° of the gastro-esophageal junction and the lower esophagus and applied U stitches at the right side of the lower esophagus to pull down and rotate the gastro-esophageal junction toward the right. Twenty-five patients underwent the standard HD and 23 patients underwent the PD-HD technique. Postoperative follow-up included barium swallow, clinical interview investigating dysphagia and reflux symptoms and endoscopy. The overall outcome was graded from excellent to poor according to the severity of symptoms and esophagitis.
The median follow-up period was 11 years (IQR 6-22) for HD group and 9 (IQR 6-14) for PD-HD (p=0.22). At postoperative barium swallow, patients in the PD-DH group had smaller esophageal diameter [4 cm (IQR 4-4.7) vs 4.7 cm (IQR 4-5), p=0.04] and lower residual barium column [10 cm (IQR 6-13) vs 6 cm (IQR 0-8), p=0.001] than those in the HD group. Postoperative moderate-severe (D2-D3) dysphagia rates were 40% for HD and 13% for PD-HD group (p=0.003). The outcome of treatment revealed satisfactory (excellent, good, fair) results in 68% and 91.4% of HD and PD-HD group patients, respectively.
The Heller-Dor operation is effective in the presence of sigmoid achalasia. The clinical and instrumental evaluations showed better results with the PD-HD technique. This technique may be the first choice for end-stage achalasia with null or low risk for cancer.
582. REPORT ON A 42 YEAR EXPERIENCE WITH THE LAPAROTOMIC/LAPAROSCOPIC HELLER-DOR OPERATION PERFORMED WITH INTRAOPERATIVE MANOMETRY FOR ESOPHAGEAL ACHALASIA
Authors: Tassi Valentina , Lugaresi Marialuisa , Baldi Fabio , Mattioli Bendetta , Daddi Niccolò , Pilotti Vladimiro , Mattioli Sandro 
Published: September 2022

Abstract
In 1979 our surgical group proposed the Heller-Dor operation (HD) to accomplish new concepts of surgical pathophysiology: to abolish the lower esophageal sphincter with the division of the U-and sling fibers of the lesser gastric curvature, to prevent GER with an effective but not too effective partial fundoplication which protects the myotomy surface. Aim is to report very long-term results of the treatment of esophageal achalasia with the Heller-Dor operation performed with intra operative manometry.
In the period 1979-2021 HD was in first instance adopted in 202 patients (97 men; median age 45 years; IQR 31–59) in laparotomy (L-HD) and in 162 (79 men; age 48 years; IQR 35–63) in laparoscopy (V-HD). At intraoperative manometry, the complete abolition of the high-pressure zone was always obtained and the Dor length and pressure were trimmed according to reference values. Follow-up consisted of interview, endoscopy and barium swallow performed every 3 years. The overall outcome was graded from excellent to poor according to the severity of symptoms and esophagitis.
Median follow-up was 14.8 years in HD, 7.5 years in V-HD (p&lt;0.001). Esophageal diameter and residual barium column decreased substantially during the first 3 years after the operation, but not successively. In the L-HD group poor results were 22 (10.9%): due to esophagitis in 17 (8.4%) and to recurrent dysphagia in 5 (2.5%). In V-HD, 4 (2.5%) had esophagitis and 2 (1.2%) severe dysphagia. Outcome was satisfactory in 89% of L-HD and in 96% of V-HD (p&lt;0.001). Postoperatively, according to the Kaplan Mayer curve, dysphagia, reflux symptoms and esophagitis occurred within 60-65 months after surgery.
Timing of dysphagia relapse and post-myotomy reflux occurrence indicate that after five years, surgical results can be considered definitive. The 96% of satisfactory results we achieved with VL-HD, at a median follow-up time of 8 years, shows the potentiality of this surgical technique. In our experience, the learning process, not the follow-up length or the laparotomy/laparoscopy method is the cause of improved results of the laparoscopy HD.
585. INDIAN SINGLE CENTRE EXPERIENCE USING CROSS PROTOL IN CARCINOMA ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION (GEJ)
Authors: Jethani Manish , Mistry Rajesh 
Published: September 2022

Abstract
Last decade has changed the treatment modality in esophageal cancer. Neoadjuvant chemoradiation followed by surgery is proven to be highly effective in locally advanced esophageal and GEJ tumors by Dutch CROSS protocol. The aim of neoadjuvant treatment is to increase R0 resection, down staging and pathological complete response which eventually increases disease free and overall survival.
This is a prospective observational single arm study of 51 patients who were treated with neoadjuvant chemoradiation with radiation therapy (RT) to 41.4 Gy/23 Fr/4.5 weeks and weekly paclitaxel and carboplatin, followed by surgery at our institute between 2013 and 2021. Eligibility for the use of CROSS protocol was expanded beyond the clinical stage T1N1 or T2-3N0-1, which includes T4aN0-1, T3N2-3.
The median age of this cohort was 58 years. 37/51 (72%) had T3 disease, 8/51 (15%) had T4a and 14/51 (27%) had N2/N3 disease. 90% patients had squamous cell carcinoma. All patients completed the intended dose of radiation; 11/51 (22%) patients had a treatment delay due to haematological toxicity; one patient died. 42 (82%) successfully completed esophagectomy with R0; one patient had inoperable disease, four defaulted and three refused surgery; 26 (62%) had pCR, 12 (28.57%) PR and one had SD. At last follow up 35 patients were alive, 12 died of disease and 7 had recurrent disease.
Our experience of neoadjuvant chemo radiation therapy (CROSS protocol) is in line with published data. Surgery post induction therapy was not associated with increased morbidity. It was associated with high complete resections and pathological complete response.
595. LAPAROSCOPIC HELLER’S MYOTOMY WITHOUT FUNDOPLICATION. CURRENT EVIDENCE
Authors: Davakis Spyridon , Liakakos Theodoros , Sdralis Ilias , Stratigopoulou Panagiota , Ntoka Polyxeni , Giagkos Christos , Andreas Alexandrou , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Achalasia is a rare esophageal motility disorder which affects the esophageal smooth muscle layer, causing absent or spastic peristalsis, and absent or partial lower esophageal sphincter (LES) relaxation with an increased LES tone. Laparoscopic Heller’s myotomy is the gold standard surgical therapy of esophageal achalasia. The role of fundoplication to minimize GERD after myotomy is debatable. We studied our experience with Laparoscopic Heller Myotomy Without Fundoplication (LHM) for the treatment of esophageal achalasia.
A retrospective analysis of prospectively collected data regarding consecutive patients that underwent LHM without fundoplication for the treatment of esophageal achalasia was conducted. All patients were operated between September 1st 2018 and January 1st 2022. Patients included in this study were adults (&gt;18 years old) without upper age limit. All participants completed a subjective dysphagia score questionnaire, received an Eckardt Score preoperatively, as well as at 6 and 12 months following the myotomy procedure. Patients that were treated with endoscopic dilation POEM or esophagectomy were excluded from the study.
Twenty-five patients underwent LHM myotomy without fundoplication during the study period. Median age was 42 years (Range: 25-90 years). Median operative time was 70 min (Range: 60-80 min). There was no conversion. Median length of stay was 2 days (Range: 1-15 days). There was one (n=1) mucosal perforation, in a 28-year-old male patient due to overeating, 4 days post LHM. He was treated with laparoscopic primary suturing. There was n=1 (4%) pathologic GERD noted post-operatively. The Eckardt score decreased from 6.5 ± 1.7 to 0.9 ± 1.4 at 1 month and to a 0.8 ± 1.1 at 12 months.
Therapy of esophageal achalasia focuses on decreasing the outflow resistance of the GEJ caused by the dysfunctional LES. LHM is considered as the gold-standard therapy for most achalasia patients. LHM is considered safe and effective, while it has been associated with excellent results regarding the relief of dysphagia. There is a reportedly low incidence of new gastroesophageal reflux symptoms. There is no need for fundoplication following LHM since the incidence of GERD is relatively low.
596. MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL AND GASTRO-ESOPHAGEAL JUNCTION TUMORS. A SINGLE CENTER EXPERIENCE
Authors: Davakis Spyridon , Liakakos Theodoros , Mpaili Efstratia , Ziogas Dimitrios , Sakellariou Stratigoula , Theochari Maria , Stratigopoulou Panagiota , Ntoka Polyxeni , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Esophagectomy carries high rates of post-operative morbidity and mortality. Minimally invasive esophagectomy was introduced more than 20 years ago offering all the advantages of minimally invasive surgery and significantly reducing post-operative pulmonary and cardiac complications associated with open esophagectomy. Clinical and oncological outcomes are vastly improved standardizing this approach as inferior in the hand of experts. Herein, we aim to present our results of minimally invasive esophagectomy for esophageal and gastro-esophageal junction cancer.
This is prospective analysis of consecutive patients that underwent 2-stage minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers. Operations included hybrid 2-stage esophagectomy (laparoscopic/open thoracotomic or open laparotomy/thoracoscopy) and 2-stage totally minimally invasive esophagectomy (laparoscopic/thoracoscopic). Study included adult patients with no upper age limit (&gt;18 years). All esophagectomies for benign disease, as well as emergency operations were excluded from the study. Primary endpoints were 30- and 90-day mortality rate, anastomotic leak, anastomotic stricture, pulmonary complications, and length of hospital stay. Secondary endpoints were overall survival and progression-free survival rates respectively.
During an 8-year-period, n=350 consecutive patients underwent 2-stage minimally invasive esophagectomy for cancer. Our team has a cumulative experience of more than 300 open-esophagectomies. Since September 1st, 2013, hybrid 2-stage esophagectomy program was initiated. On September 1st, 2016, the program offered 2-stage totally minimally invasive esophagectomy in-all comers. Most patients were males. Anastomotic leak complicated 5.1% of the patients; 10% of the patients presented anastomotic stricture post-operatively, while pulmonary and cardiac complications reached up to 25 and 12% respectively. Medial LOS was 8 days. Median follow-up was 60 months. OS survival rate was 53 months and PFS was 48 months.
Advances in minimally invasive surgery can benefit all patients with esophageal and gastro-esophageal junction tumors. Hybrid and totally minimally invasive 2-stage esophagectomy are well established approaches, with safe and feasible profile in tertiary cancer centers. They can lead to significantly improved clinical and oncological outcomes comparing to open esophagectomy and its complications burden.
597. THE ROLE OF SURGERY IN THE ESOPHAGEAL INVOLVEMENT IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITTERATURE REVIEW
Authors: Cerinic Pietro Matucci , Akpabio Akpabio , Hughes Michael , Schoones Jan , Terrosu Giovanni , Martino Antonio , Vecchiato Massimo , Petri Roberto , Cerinic Marco Matucci , Alunno Alessia 
Published: September 2022

Abstract
In Systemic Sclerosis (SSc), gastroesophageal reflux disease (GERD) occurs in 75% of patients. Chronic doses of proton pump inhibitors may elicit in the general population long-term risk. When medical therapy fails, surgery can be employed but consensus on surgical procedures for refractory GERD is still lacking in SSc. Our aim was to evaluate the surgical approaches employed in the management of refractory GERD with a systematic literature research (SLR).
Four research questions, based on the PICO framework, guided the SLR which was conducted up to December 22nd, 2021. The search was performed across different databases including PubMed, MEDLINE (OVID), EMBASE, Cochrane Library, Web of Science, Google Scholar, Emcare and Academic Search Premier. References were independently screened by two reviewers (PMC and AA) who also independently assessed the full text of eligible articles, and extracted data. Due to heterogeneity of retrieved studies, narrative summaries are used to present the data.
In 30/916 papers, eligible for review, 348 patients were identified: 257 underwent an anti-reflux surgical procedure and included in the analysis. Refractory GERD was the most frequent indication for surgery, and post-operative dysphagia was a frequent complication. In 18 studies, fundoplication (FP) was effective, whereas 4 studies had equivocal findings and 5 didn’t report efficacy. Surgical procedures have changed in time: overall, the Collis-Nissen FP was the most popular in old studies, followed by Nissen FP, while Dor FP has been used more recently. The data extracted show also an acceptable rate of mortality and morbidity related to surgery.
In SSc, FP seems a safe and effective procedure for GERD management. In many studies, transient post-operative dysphagia was related with the posterior FP. Our SLR shows that the surgical management of GERD is still highly challenging and minimal requirements should be provided to perform surgical studies in SSc, designing studies to define clinical criteria for surgical referral. In SSc, the right timing for surgery and the best surgical procedure still remain an unmet need.
598. EPIPHRENIC DIVERTICULUM CAUSING GASTROESOPHAGEAL JUNCTION OUTFLOW OBSTRUCTION (EGJOO)
Authors: Lee June , Lim Annabelle , Lim Xin Yan 
Published: September 2022

Abstract
Oesophageal diverticulum is a rare cause of dysphagia. They are classified based on location- Zenker’s diverticulum distal to the cricopharyngeus; epiphrenic diverticulum above the lower oesophageal sphincter (LES)- or pathophysiology – traction vs pulsion. The prevalence of epiphrenic pulsion diverticulum ranges from 0.2% to 0.8%. We present a case of epiphrenic diverticulum and its management.
A 68 year old lady presents with dysphagia to solids and liquids, belching, food regurgitation, and acid brash for 10 years. She had no loss of weight, but experienced daily regurgitation and occasional retrosternal pain. Physical examination was unremarkable. We worked her up with further investigations and scans.
A CT abdomen reported a hiatus hernia and mural thickening of distal oesophagus with upstream oesophageal distension. A oesophagogastroduodenoscopy showed residual food in oesophagus. The lower oesophagus was dilated and the LES appeared tight with no masses. There was no hiatus hernia on endoscopy. Barium swallow revealed the lower oesophageal dilatation to be an epiphrenic diverticulum. Manometry studies showed oesophago-gastric junction outflow obstruction.
She underwent laparoscopic excision of esophageal diverticulum, cardiomyotomy and anterior partial fundoplication. The video serves to highlight the surgical key steps. She was discharged on post-operative day 3 without complications and barium swallow pre/post op as shown.
Oesophageal diverticulum, although rare, remains a differential for dysphagia. For epiphrenic diverticulum, it is important to understand that this is a pulsion diverticulum, with an accompanying gastro-oesophageal outflow obstruction. In addition to surgical management with a laparoscopic diverticulectomy, a cardiomyotomy and partial fundoplication to treat underlying motility disorder is important. This case study and video serves to highlight the condition and present minimally invasive surgical management.
599. TOLL-LIKE RECEPTORS AND ESOPHAGEAL CANCER. DIAGNOSIS, PROGNOSIS AND THERAPY
Authors: Davakis Spyridon , Kapelouzou Alkistis , Sakellariou Stratigoula , Mpoura Maria , Stergiou Dimitrios , Liakakos Theodoros , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Esophageal cancer is the sixth leading cause of cancer related morbidity worldwide. It has to predominant subtypes, esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Despite all the advances in surgical therapy and adjuvant therapies, prognosis of esophageal cancer remains poor. EAC develops through Barrett’s esophagus (BE) and columnar dysplasia, preceded by gastro-esophageal reflux disease (GERD). Incidence of ESCC is increased with tobacco smoking and alcohol abuse.
Toll-like receptors (TLRs) can act as prognostic factors and potential therapeutic targets of esophageal cancer. TLRs, an important family of pattern recognition receptors, allow immune cells to recognize pathogens, triggering inflammation. TLRs-signaling pathway activates signaling elements, regulating inflammatory response, possibly correlating to carcinogenesis. In normal esophagus, TLRs play an important role in innate immunity, recognizing molecular patterns on microorganisms and inflammatory responses produced by tissue damage.
It is known that TLR3, TLR4, TLR5 and TLR are increasingly expressed from GERD to AC, with TLR4 known for being a mediator of proliferation in AC, while TRL1 and TLR4 overexpression in AC is related to poor prognosis and metastatic potential. Additionally, TLR3, TLR4 and TLR9 expression in stromal cells of ESCC has been associated with lymphatic metastasis, while TLR7 and TLR9 increased expression has also been addressed to advanced disease.
Herein, we aim to present all available data regarding the relations of TLRs and EC. It seems that TLRs expression can indicate esophageal metaplasia, dysplasia, and cancer. Toll-like receptors can act as significant and valuable indications in diagnosis, prognosis and potentially can be used as therapeutic target of esophageal cancer.