bluuebunny/crossref_metadata_2025_split huggingface dataset:
139. DOES POSTOPERATIVE NON-INVASIVE VENTILATION INCREASE THE RISK FOR COMPLICATIONS IN CHILDREN POST-REPAIR OF ESOPHAGEAL ATRESIA?
Authors: Zheng Maye , Ravindranathan Hari , Lui Kei , Krishnan Usha 
Published: September 2022

Abstract
The primary aim of this study was to determine if postoperative use of high flow nasal cannula (HFNC) and/or continuous positive airway pressure (CPAP) are independent risk factors for adverse postoperative outcomes after surgical repair of Esophageal Atresia (EA). Secondary aims were to determine other significant clinical risk factors associated with these adverse outcomes.
A retrospective chart review was conducted on all EA neonates repaired and managed postoperatively between 2007-2020 across two centres: Sydney Children’s Hospital (SCH) and The Royal Hospital for Women (RHW). The primary outcome measure was anastomotic leakage (AL), and other outcome measures included anastomotic stricture (AS), mediastinitis, sepsis, and pneumothorax. Significant associations were identified using Chi-square, and univariate and multivariate logistical regression models (p &lt; 0.05).
We reviewed 104 charts. Post-repair, all were placed on invasive mechanical ventilation (IMV) (median of 119.50 hours). Of these, 45 (43.3%) were subsequently bridged with some form of NIV post-extubation, with 33 each on HFNC and CPAP. 59 (56.7%) developed at least one postoperative complication: 12 had AL, and 17 had AS. After adjustment, no significant association was found between HFNC or CPAP use with development of AL (p = 0.074 and p = 0.859), or any other adverse outcome. Independent risk factors for AL include anastomosis under tension and type B EA. Delayed first oral intake significantly increased risk of mediastinitis and sepsis.
Our results show no increased risk of AL or any other adverse postoperative event with use of non-invasive ventilation in form of HFNC and/or CPAP. Reducing anastomotic tension during primary repair of OA-TOF and introducing early oral feeding appears to be protective and reduces risk of AL and infection. However, further prospective research is still needed to help guide post extubation ventilation strategies in this population.
156. ANTI-REFLUX RADIOFREQUENCY THERAPY USING STRETTA FOR REFRACTORY GORD IS FEASIBLE AND REDUCES THE NEED FOR MINIMALLY INVASIVE SURGERY
Authors: Joel Abraham , Konjengbam Alakh , Frank Helen , Hammond Emily , Kuttuva Shivani , Cowie Stuart , Mbarushimana Simon , Kourounis Georgios , Hidayat Hena , Thulasiraman Sri , Viswanath YKS 
Published: September 2022

Abstract
Radiofrequency (RF) therapy of the lower oesophageal sphincter using STRETTA strengthens the reflux barrier across the gastro-oesophageal junction. Numerous studies have shown improvement in reflux symptoms, reduction in proton pump inhibitor (PPI) dependence and need for surgical treatment for gastro-oesophageal reflux disease (GORD). We present the largest series from Europe, and aim to assess long term outcomes of STRETTA for patients with medically refractory GORD.
Data for all patients who underwent STRETTA from October 2014 till April 2021 were prospectively maintained on a database and was analysed retrospectively. Patients and primary care doctor practices were contacted to obtain information on PPI free period (PFP) after STRETTA therapy, which was defined as the time between STRETTA and recommencement of prescribed and daily consumption of PPI medication. As required medication use was not considered for PFP calculation. Statistical analysis and graphical presentation were carried out using Minitab® and GraphPad Prism®. Mann–Whitney test was used to compare two sets of non-parametric data and a p &lt; 0.05 was considered significant.
From 195 patients (median age 55, 116 females (59%)) who underwent STRETTA, PFP data were available for 144 (74%) patients. Sixty-six patients (45%) remained without PPI after a median follow-up of 4.5 years (52 months). Six patients (3%) went on to have a further intervention. There was a significant negative correlation between PFP and age (p = 0.023) with no differences between the genders (p = 0.90). Patients &lt;55 years had a longer PFP than &gt;55 years (p = 0.012). Younger males had a significantly longer PFP than older males (0.03). However, this was not observed in the female cohort (p = 0.14).
Our findings suggest STRETTA as a safe and feasible option for treating medically refractory GORD, especially in younger patients. STRETTA does reduce the need for long term PPI and lessens the frequency of further interventions such as surgery. Further studies are required to investigate the mechanisms by which STRETTA is beneficial in the younger patient.
162. EXPERIENCE IN PRIMARY REPAIR OVER T TUBE IN IATROGENIC OESOPHAGEAL PERFORATION
Authors: Latif Mohd Danial Abd , Sarif Mat Salleh 
Published: September 2022

Abstract
Iatrogenic oesophageal perforation can be a devastating event following endoscopic or surgical procedures. It remains a challenge for the surgeon to intervene. The most common cause of oesophageal perforation which accounts for about 70% of the cases is iatrogenic perforation with mortality ranging from about 10 to 25%. Most of the iatrogenic perforations are from endoscopic procedures. This case report like to highlight one of the treatments for iatrogenic oesophageal perforation.
A 73-year-old female presented to the ORL team with the inability to swallow and associated with choking sensation and drooling of saliva for 2 days. The patient developed intrascapular pain post-Rigid Esophagoscopy which intensified postprandially, and developed respiratory distress with excruciating pain over the centre of the chest anteriorly and intrascapular region. Examination revealed reduce air entry of the right lung with Xray revealed right pneumothorax with a collapsed lung. CT Thorax revealed mid-oesophageal injury at above the carina with extravasation of oral contrast.
Oesophagogastroduodenoscopy, Right Thoracotomy, Primary Oesophageal perforation repair over T-tube, Right Thoracic Decortication, and Washout were done.
Defect at mucosa anteriorly with stricture 23 cm and submucosal flap 28 cm from the incisor into the left thoracic cavity with perforation at the right lateral wall of the oesophagus 5 cm below the azygos vein crossing point. Myotomy performed and T-tube catheter inserted as control fistula. Oesophageal repair done and 2 chest tubes inserted at the site of perforation and base of thorax. Intraoperatively right lung expanded well. A contrast swallow study on day 46 shown no evidence of fistula between trachea and oesophagus or leak. The surveillance endoscope showed remarkable healing.
Iatrogenic oesophageal perforation remains amongst the main causes for oesophageal emergencies which require proper planning, and prompt management. Proper selection of both non-operative and operative management are interchangeable with the time, and progression of a patient’s conditions. As these cases are rarely encountered thus such cases should be managed at a centre that is equipped with a trained, and experienced specialist unit, thus preventing misdiagnosis, undertreated treatment, and unwanted outcomes.
174. IMPACT OF WEEKEND EFFECT ON SHORT- AND LONG-TERM SURVIVAL OF PATIENTS UNDERGOING ESOPHAGECTOMY FOR CANCER: A POPULATION-BASED, PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Yang Tzu Yi 
Published: September 2022

Abstract
The question as to whether the weekend effect can have an impact on the survival outcomes of patients undergoing esophagectomy for cancer remains unanswered.
This was a retrospective analysis of a nationwide health administrative dataset that included all patients (n = 3235) who had undergone elective esophagectomy for cancer between 2008 and 2015. Patients were categorized according to the day of surgery (weekday group [Monday through Friday], n = 3148; weekend group [Saturday or Sunday], n = 87). Propensity score matching computed using inverse probability of treatment weighting (IPTW) was applied to reduce bias due to baseline differences.
After IPTW weighting, patients undergoing esophagectomy on weekends had a higher 90-day mortality rate compared with those undergoing surgery on a weekday (10.5% versus 5.5%, respectively, P &lt; 0.001). After controlling for potential confounders, weekend surgery was identified as an independent adverse predictor of 2-year overall survival (hazard ratio = 1.38, P &lt; 0.001). Importantly, inferior weekend outcomes were especially evident in certain subgroups, including patients aged &gt;60 years as well as those with a high burden of comorbidities, advanced tumor stage, a histological diagnosis of squamous cell carcinoma, and treated with minimally invasive esophagectomy (all P &lt; 0.001).
Elective esophagectomy for cancer during weekends has an adverse impact on short- and long-term survival.
180. SINGLE-PORT MEDIASTINOSCOPIC LYMPHADENECTOMY IN THE UPPER AND MIDDLE MEDIASTINUM USING CONTINUOUS INTRAOPERATIVE NERVE MONITORING
Authors: Fujiwara Hitoshi , Shiozaki Atsushi , Konishi Hirotaka , Kubota Takeshi , Ohashi Takuma , Otsuji Eigo 
Published: September 2022

Abstract
The left cervical approach with single-port mediastinoscopy is essential for radical esophagectomy without thoracotomy for esophageal cancer, which provides excellent visibility and handling along the esophagus to achieve radical lymph nodes (LNs) dissection in the upper and middle mediastinum. However, the transcervical procedure dissecting along the recurrent laryngeal nerve (RLN) requires careful use of both energy device for dissection and forceps for surgical field expansion to minimize the risk of RLN palsy.
Using the left cervical approach, the LNs along the left RLN and tracheal bifurcation (subcarinal and bilateral main bronchial LNs) were dissected en bloc with the esophagus. The LNs along the right RLN were basically dissected through a right cervical incision under direct vision or dissected with the left cervical approach if visible. Intraoperative nerve monitoring (IONM) with NIM Response 3.0 was introduced to minimize the risk of RLN palsy. Continuous and intermittent IONMswere used for the left and right cervical procedures, respectively.
Until March 2019, 175 patients underwent transmediastinal esophagectomy. Squamous cell carcinoma was predominant (93.7%). The upper and middle thoracic tumors were the most frequent (65.7%). Since IONM introduction, RLN palsy (grade I or more, CD classification) was significantly reduced. Without IONM (n = 106), the left RLN palsy was observed in 35.9%, while was in 13.6% with IONM (n = 66). In addition, the bilateral RLNs palsy was 14.2% without IONM, while was reduced to 3.0% with IONM.
IONM is useful to reduce RLN palsy in transmediastinal esophagectomy. Especially, continuous IONM, which provides a real-time information on the risk procedure of RLN injury, is effective in preventing RLN palsy. The left cervical procedure with continuous IONM will be shown in movie.
196. RISK FACTORS OF CERVICAL LYMPH NODE METASTASIS IN ESCC AND ESTABILISHMENT OF PREDICTION MODEL
Authors: Gong Taiqian 
Published: September 2022

Abstract
Cervical lymph node metastasis of esophageal squamous cell carcinoma (ESCC) is an important basis for lymph node dissection of ESCC. Now, there are still disputes about whether to perform two field lymph node dissection or three field lymph node dissection. Establishing prediction model by analysis big data could promote the accuracy of prediction of cervical lymph node metastasis in patients with ESCC which can help clinicians to select individualized surgical scheme for patients.
The clinical data of 102 consecutive patients with ESCC who underwent radical esophagectomy and three-field lymph node dissection between December 2015 to December 2021 were retrospectively analyzed. They were divided into positive group and negative group according to cervical lymph node metastasis. The differences between the two groups were compared, and after the univariate analysis those who were statistically significant were included in multivariable logistic regression analysis to establish the risk prediction model and plot a nomogram by software R.
Among the 102 patients, univariate analysis(P&lt;0.2)indicated that cervical lymph node metastasis of ESCC was related to the distance from upper edge of the tumor to the incisors (P = 0.101), vascular invasion (P = 0.144) and recurrent laryngeal nerve lymph nodes metastasis (P = 0.159). Multivariate logistic regression analysis showed that the distance from upper edge of the tumor to the incisors (P = 0.032) and the vascular invasion (P = 0.147) were independent risk factors. The AUC of ROC curve is 0.6817 (95% confidence interval: 0.5775–0.7859) and the Youden index is 0.294, 95% CI (0.620, 0.742).
The prediction model includes two variables: the distance from upper edge of the tumor to the incisors and the vascular invasion. It plays a certain role in predicting the risk of cervical lymph node metastasis of ESCC, and can assist doctors in individualized treatment for patients with ESCC.
199. FAVORABLE OUTCOMES OF JEJUNAL INTERPOSITION RECONSTRUCTION WITHOUT VASCULAR ANASTOMOSIS AFTER ESOPHAGECTOMY FOR CANCER: A SINGLE-CENTER EXPERIENCE OVER TWO DECADES
Authors: Zhao Lilan , Pan Xiaojie , Lin Zhaoxian , Chen Wenshu , Guo Tianxing , Zhu Lihuan , Ou Debin 
Published: September 2022

Abstract
The standard esophageal replacement after esophagectomy for cancer treatment is a gastric conduit. However, when the stomach is not available, a jejunal interposition can be performed under such circumstances. The purpose of this study was to review our experience with this technique especially without requiring microvascular anastomosis of artery or vein, and assess the surgical outcomes.
We retrospectively reviewed the medical records of patients with esophageal cancer who underwent jejunum interposition without vascular anastomosis at our institution from 2003 to 2020. Data pertaining to patient characteristics, operative technique, and postoperative outcomes were collected and analyzed. Factors affecting oncologic outcomes were assessed by Kaplan–Meier estimates and Cox proportional hazards regression analyses. Postoperative quality of life were evaluated by a standard questionnaire.
After 38 months of median follow-up time, 132 patients (122 males and 10 females; aged 40 to 86 years) were included. More than half of the patients (55.3%, 73/132) were above stage III. The operation time required was 294.5 ± 89.7 min, and the drainage time was 8.0 ± 5.3d. Fiveteen patients underwent cervical anastomosis. The anastomotic leakage rate was only 4.5% (6/132) among all the patients. The 90-days mortality rate was 5.3% and the overall survival at 1, 3 and 5 years were 91.7%, 76.8% and 61.8%, respectively. The prognosis was mainly correlated with tumor stage and most patients showed good quality of life.
This is the largest series of jejunal interposition in a single institution from China. The nearly 20-year follow-up data suggests that, even without vascular anastomosis, the procedure using jejunum as an alternative conduit is a feasible procedure for reconstruction after esophagectomy, resulting in low morbidity and favorable prognosis.
203. ESTABLISHING A MASS SPECTROMETRY BASED DIAGNOSTIC TEST FOR OESOPHAGEAL CANCER
Authors: Bringans Scott , Duong Marisa , Laming Connor , Di Prinzio Patsy , Hill Michelle , Lipscombe Richard 
Published: September 2022

Abstract
Diagnosis of oesophageal adenocarcinoma, or Barrett’s oesophagus, a pre-malignant condition associated with an increased risk of the adenocarcinoma, currently requires expensive and invasive endoscopy-biopsy procedures, which are often only performed when obvious symptoms have manifested (usually at a late stage of the disease). A targeted mass spectrometry-based method was developed to analyse serum samples for oesophageal adenocarcinoma.
Panels of lectin-pulled down serum protein biomarkers were identified that correlate with the presence of early stage oesophageal adenocarcinoma (high grade dysplasia). The method was automated and optimised the methodology to measure 33 target peptides in the lectin pulldown in a short 20 minute mass spectrometry run.
Analysis of an initial cohort (n = 50) shows the method to be robust and reproducible with an average intraday CV of 9.3% across the 33 peptides and an average interday CV of 11.5%. A larger cohort (n = 266) showed consistent results and was used to build statistical models which distinguished between disease status, using protein biomarker measurements and simple clinical parameters. Several models achieved good discrimination with AUROC values ranging from 0.89–0.97. Model validation was undertaken in the smaller cohort, with the two best performing models achieving AUROC values of 0.82 and 0.87.
The assay has the potential to produce a clinically viable diagnostic test to support screening and early detection in populations at high risk of oesophageal adenocarcinoma and Barrett’s oesophagus.
206. SINGLE-CELL RNA-SEQ ANALYSIS REVEALS ACCELERATED PROLIFERATION OF ESOPHAGEAL EPITHELIAL CELLS TO ELIMINATE NRF2-ACTIVATED CELLS
Authors: Hirose Wataru , Horiuchi Makoto , Taniyama Yusuke , Kamei Takashi , Taguchi Keiko , Yamamoto Masayuki 
Published: September 2022

Abstract
Nrf2 is a transcription factor that regulates cytoprotective genes in response to oxidative and electrophilic stresses. The activity of Nrf2 is mainly controlled by the protein degradation by Keap1, a ubiquitin E3 ligase adaptor. Most of esophageal squamous cell carcinomas (ESCC) exhibit constitutive Nrf2 activation by Keap1 dysfunction, resulting in the poor prognosis. However, it has not been clarified whether Nrf2 activation serves as the initiation in tumorigenesis of ESCC.
We generated tamoxifen-inducible and squamous epithelium-specific Keap1 conditional knockout (Keap1-cKO) mice in which Nrf2 is activated segmentally in esophageal epithelium at the adult stage. Using Nqo1 that is a representative Nrf2 target gene as the marker of Nrf2-acitivated cells, we distinguished Keap1-deleted/Nrf2-activated cells and Nrf2-normal cells in immunohistochemical analysis and gene expression analysis. Single-cell RNA-seq (scRNA-seq) analysis was conducted to compare the gene expression of Nrf2-activated cells and Nrf2-normal cells from Keap1-cKO mice, and control cells from control mice.
In Keap1-cKO mice, Nrf2-activated cells accounted for 35% at 1 week and 20% at 4 weeks after induction of Keap1 deletion. This decrease was based on observations that Nrf2-activated cells were eliminated from the epithelium due to the weakened attachment to the basement membrane. In contrast, DNA damage accumulated in Nrf2-normal cells neighboring Nrf2-activated cells. To clarify the cell fate in the esophagus, we compared Nrf2-normal cells to Nrf2-activated cells or control cells in scRNA-seq analysis. Gene sets of G2/M checkpoint and E2F targets, which regulate cell proliferation, were enriched in Nrf2-normal cells.
Constitutive Nrf2 activation renders esophageal epithelial cells able to be selectively eliminated via cell competition. Nrf2-normal cells suffered from DNA damage, but not Nrf2-activated cells, have a potency to be an origin of ESCC. These results suggest that Nrf2 activation serves as a tumor promoter of ESCC, but not the initiator. We speculate that the other gene mutations such as Tp53 are needed for the initiation to form ESCC prior to Nrf2 activation.
220. DOES LYMPH NODE YIELD IMPROVE WITH ADVANCING TECHNOLOGIES IN OESOPHAGECTOMIES: 12 YEARS ON
Authors: Chaudhury Madhu , Singh Mohan , Shetty Vinutha Daya , Ward Jeremy , Ball Chris , Turner Paul , Pursnani Kishore 
Published: September 2022

Abstract
Oesophagectomy involves resection of tumour along with surrounding lymph nodes (LN). One of the quality indicators suggesting successful oesophagectomy is the number of LNs retrieved in dissection. Current available data remains controversial on benefits of high lymph node yield for patient receiving neoadjuvant and on disease-free survival. In our cancer centre, we have evolved in performing Oesophagectomies from open to laparoscopic to more recently robotically (Da Vinci Xi, Intuitive Surgical) over the last 3 years.
This was a retrospective study using the electronic database containing information on patients who underwent elective cardio-oesophagectomy from April 2009 to December 2021 in a Tertiary Upper GI cancer centre. SPSS V22 was used to calculate any statistical difference (p &lt; 0.05).
A total of 560 patients underwent cardio-oesophagectomy. The median length of stay was 13 (Range 3 to 148) days and the median age was 62 (49–79) years. M/F 2:1. The median lymph node yield between open, MIO and robot 17 (12–45) nodes, 15 (11–40) and 17 (0–31) respectively. Non parametric comparisons were made between each group, the p-value found in each group (details on table, attached separately).
Our robotic data is still at its infancy. Based on our current findings, it suggests the trend that with advancement in technology resulting in better visualization of anatomy as well as improved economy of movement during robotic surgery, there is the advantage of increased lymph node yield which can contribute to improving patient prognosis.
230. ENDOSCOPIC REFERENCE SCORE REMODELING SUBSCORE AND ESOPHAGEAL EOSINOPHIL COUNT DO NOT CORRELATE IN PLACEBO-TREATED EOSINOPHILIC ESOPHAGITIS PATIENTS FROM DUPILUMAB STUDIES
Authors: Hirano Ikuo , Rothenberg Marc E , Spergel Johnathan M , Aceves Seema , Greenhawt Matthew , Schoepfer Alain M , Philpott Hamish , Chen Zhen , Radwan Amr , Khodzhayev Angela , Deniz Yamo , Rowe Paul J , Pela Tiffany , Jacob-Nara Juby A 
Published: September 2022

Abstract
Although eosinophils are the hallmark of eosinophilic esophagitis (EoE) with threshold levels required for diagnosis, their exact role in EoE is unclear. The EoE-Endoscopic Reference Score (EREFS) assesses endoscopic inflammatory (edema/exudate/furrows) and remodeling (rings/strictures) features. We assessed the correlations between peak esophageal intraepithelial eosinophil count (eos/high-power field [hpf]) and EREFS in placebo-treated EoE patients from two clinical trials: phase 2 proof-of-concept (POC; NCT02379052; n = 24) and part A of phase 3 TREET (Phase3-PartA; NCT03633617; n = 39).
POC was a 12-week trial in adults and Phase3-PartA was a 24-week trial in adults and adolescents. Endoscopic examination of the esophagus was performed at baseline (BL) and end of treatment (EOT) and scored for inflammatory and remodeling subscores and total score using EREFS (higher scores indicate greater severity). Peak eos/hpf was measured from pinch biopsies of proximal, mid, and distal esophagus at BL and EOT. Pearson correlations were performed between total/proximal/mid/distal eos/hpf and EREFS total, subscores, and components at BL, EOT, and for change from BL at EOT.
Some strong correlations (r &gt; 0.5) were observed between total peak eos/hpf and EREFS at BL in both studies and at EOT in Phase3-Part A (Table). Moderate-to-strong correlations (r &gt; 0.3) were observed between total peak eos/hpf and EREFS inflammation subscore and edema/exudates/furrows individual components (some P &gt; 0.5) in both studies. Correlations of total peak eos/hpf with EREFS remodeling subscore and rings/stricture components were not significant (P = 0.07–0.94). Peak eos/hpf in the proximal, mid, or distal esophagus were more strongly associated with EREFS inflammation subscore (majority moderate-to-strong correlations; P = 0.001–0.66) than EREFS remodeling subscore (weak correlations, P = 0.22–0.99) at BL/EOT for both studies.
In these EoE patients, moderate-to-strong correlations were observed between eos/hpf and endoscopic markers of inflammation. No strong correlations were observed between total, proximal, mid, or distal peak eos/hpf and endoscopic parameters of remodeling. These data support a role for intact eosinophils in inflammatory changes in the esophagus in EoE and demonstrate the need for both histology and endoscopic evaluation. Further study, with larger sample sizes, is required to verify these findings in other contexts.