bluuebunny/crossref_metadata_2025_split huggingface dataset:
233. ENDOSCOPIC REFERENCE SCORE AND HISTOLOGICAL SCORING SYSTEM ARE COMPLEMENTARY ASSESSMENTS FOR CHARACTERIZING FIBROSTENOTIC OR INFLAMMATORY PHENOTYPES IN EOSINOPHILIC ESOPHAGITIS PATIENTS
Authors: Collins Margaret H , Rothenberg Marc E , Bredenoord Albert J , Wechsler Joshua , Chehade Mirna , Philpott Hamish , Chen Zhen , Radwan Amr , Pela Tiffany , Khodzhayev Angela , Jacob-Nara Juby A , Deniz Yamo , Rowe Paul J 
Published: September 2022

Abstract
The Histologic Scoring System (HSS) assesses severity/extent of histologic features (eosinophil density [ED]/basal zone hyperplasia [BZH]/eosinophil abscesses [EA]/eosinophil surface layering [SL]/surface epithelial alteration [SEA]/dyskeratotic epithelial cells [DEC]/dilated intercellular spaces [DIS]/lamina propria fibrosis [LPF]) in eosinophilic esophagitis (EoE). The Endoscopic Reference Score (EREFS) assesses endoscopic feature severity (edema/exudates/furrows/rings/strictures). We correlated HSS components with inflammatory/remodeling EREFS components in placebo-treated EoE patients from 2 trials—phase 2 proof-of-concept (POC; NCT02379052), phase 3 TREET part A (Phase3-PartA; NCT03633617).
POC was a 12-week trial in adults, and Phase3-PartA was a 24-week trial in adults and adolescents. Proximal/mid/distal esophagus biopsies were collected at baseline/end of treatment (EOT) and scored by HSS for grade (severity)/stage (extent)/components (higher scores = greater severity). Endoscopies were scored by EREFS (higher scores = greater severity) and inflammatory (edema+exudates+furrows) and remodeling (rings+stricture) subscores calculated. Pearson correlation and single co-variate regression model analyses were performed between baseline HSS grade/stage, total/individual components scores and EREFS total/components scores and subscores, and for the change in scores from baseline at EOT (ΔEOT).
Moderate-to-strong correlations (r &gt; 0.3) were observed between total EREFS and HSS grade/stage for baseline/ΔEOT in POC and baseline in Phase3-PartA (Table). Moderate correlations were observed between BZH and EREFS remodeling subscore and rings for ΔEOT in Phase3-PartA; DIS grade and EREFS remodeling subscore and strictures for baseline and ΔEOT in POC but not Phase3-PartA; and EREFS inflammation and remodeling subscores and components for SEA and SL at baseline and ΔEOT in POC. Moderate-to-strong correlations were observed between EREFS inflammation subscore and DIS stage and between edema and DIS grade/stage at baseline in both studies. Similar results were observed using regression analyses.
Specific components of HSS and EREFS, reflecting inflammatory and remodeling processes, are closely correlated, when examined by Pearson correlations or regression analyses, and can aid identification of fibrostenotic or inflammatory phenotypes in EoE. Correlations of DIS with endoscopic inflammatory and remodeling features reflect the role of barrier dysfunction in maintaining chronic inflammation that ultimately leads to remodeling.
237. DIFFERENTIAL CLONAL EVOLUTION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN RESPONSE TO NEO-ADJUVANT CHEMORADIOTHERAPY
Authors: Weng Zelin , Yuan Jianye , Xie Xiuying , Wen Jing 
Published: September 2022

Abstract
As a major component of esophageal squamous cell carcinoma (ESCC) treatment regimen, neo-adjuvant chemoradiotherapy (NCRT) affects ESCC genome is largely unknown. Deciphering the evolutionary history of ESCC following NCRT would reveal dynamic mutational processes and enable us identify the key molecular features associated with NCRT-resistance.
We performed whole exome sequencing (WES) on matched pre-NCRT endoscopic biopsy tissue (n = 29), post-NCRT cystectomy tumor tissue (n = 30). On the basis of a rigorous evaluation of estimated percentage of the estimated percentage of vital residual tumor cells, 29 pre-NCRT cases were classified into two groups: major response (n = 20) and minor response (n = 9). The computational method PyClone was used to define subclones within each tumor. The method Clonality Inference in Tumors Using Phylogeny (CITUP) was subsequently used to infer phylogenetic relationships among subclones.
By comparing the subclonal composition of each patient before and after NCRT, we found that resistant subclones were polyclonal and driver mutations improved the fitness of resistant subclones. The number of driver mutations existed in resistant subclones was positively related to the size of subclones. The most frequent driver genes in resistant subclones identified in our research included TP53, NOTCH1 and a novel gene RYR3.
Multi resistant subclones result in the resistance of ESCC genome to NCRT. The fitness of resistant subclones is relevant to the number of driver mutations.
243. INTRALUMINAL OXYGEN DELIVERY AT THE SITE OF THE ANASTOMOSIS AFTER A ROBOT ASSISTED MINIMAL INVASIVE ESOPHAGUS RESECTION; A FEASIBILITY STUDY
Authors: van der Steen Douwe , Leferink Anne M , Spruit Rutger J , van Etten Boudewijn , Dijkstra Frederieke A , Verhage Roy J , Keus Eric , Kolkman Jeroen J , Haveman Jan Willem 
Published: September 2022

Abstract
Anastomotic leakage (AL) is a severe complication after esophagus resection surgery. It is thought that local ischemia of the gastric conduit is one of the main reasons for the relative high incidence of AL (10–20%). Intraluminal oxygen delivery at the site of the anastomosis might improve the viability of the tissue and therefore reduce the incidence of AL. We present a feasibility study to the intraluminal oxygen delivery after an esophagus resection.
Patients undergoing a robot assisted minimal invasive esophagus resection with an intrathoracic anastomosis were included in the study. Intraluminal oxygen was administered via an esophagus manometry catheter. In the control group, consisting of 3 patients without oxygen delivery, only intraluminal pressure measurements were conducted. In the next 10 patients, 1 mL/minute of oxygen was given in the first 5 days after surgery. Primary endpoint was the feasibility of successful placement of the catheter at the right position. In addition, patients were asked to evaluate the comfort of the setup with the use of a daily visual analogue scale.
In 2 patients, intraoperative placement of the catheter did not succeed. These patients were replaced by 2 others according to the study protocol. Therefore, in total 15 patients were analyzed. In 4 patients, the catheter was accidently luxated or removed before the end of the study. No catheter related complications were observed. The measured intraluminal pressure stabilized on an average value of 7.6 mm Hg (± 2.1). As expected, the experiences comfort was decreasing over time. See the table 1 below for details on comfort evaluation of the catheter setup.
This study shows that it is feasible to administer intraluminal oxygen in the first 5 days after a robot assisted minimal invasive esophagus resection. Future studies are required to prove the effectiveness of intraluminal oxygen delivery and its effect on AL. When the effectiveness study shows promising results, the optimal dosage and period of oxygen delivery will have to be determined.
247. ALBUMIN AND DERIVED NEUTROPHIL-TO-LYMPHOCYTE RATIO IS A NOVEL PROGNOSTIC FACTOR FOR PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Abe Tomoki , Oshikiri Taro , Goto Hironobu , Kato Takashi , Horikawa Manabu , Sawada Ryuichiro , Urakawa Naoki , Kanaji Shingo , Matsuda Takeru , Kakeji Yoshihiro 
Published: September 2022

Abstract
Various nutritional and inflammatory biomarkers have been reported to be associated with cancer prognosis, but most studies have focused on conditions before neoadjuvant chemotherapy (nCT). Developing real-time biomarkers reflecting changes in systemic conditions during nCT is important. We established a novel biomarker, represented as the albumin to derived neutrophil-to-lymphocyte ratio (Alb-dNLR ratio), and calculated the change in Alb-dNLR ratio (ΔAlb-dNLR) during nCT. We aimed to evaluate whether ΔAlb-dNLR is associated with prognosis in ESCC patients.
We investigated 172 patients who underwent nCT before esophagectomy between April 2010 and March 2018. dNLR was calculated as the ratio of neutrophil count to (white blood cell count—neutrophil count), Alb-dNLR ratio was calculated by dividing serum albumin level by dNLR, and ΔAlb-dNLR was evaluated by dividing the post-Alb-dNLR ratio by the pre-Alb-dNLR ratio. Patients were divided into ‘high’ and ‘low’ groups according to ΔAlb-dNLR.
Thirty-nine patients (22.7%) had a low ΔAlb-dNLR (≤0.8). The 5-year overall survival (OS) rates in patients with low and high ΔAlb-dNLR were 38.1% and 53.6%, respectively (p = 0.0072). Multivariate analyses demonstrated that estimated blood loss (p = 0.044), pathological T stage (p = 0.0005), pathological N stage (p = 0.017), and ΔAlb-dNLR (p = 0.005) were independent prognostic factors for OS.
ΔAlb-dNLR is a useful prognostic factor for OS in patients with ESCC receiving nCT.
254. TODAY’S ISSUES IN ROBOT-ASSISTED ESOPHAGECTOMY
Authors: Taniyama Yusuke , Okamoto Hiroshi , Sato Chiaki , Ozawa Yohei , Ishida Hirotaka , Koseki Ken , Kato Nobufumi , Yamauchi Takuro , Kamei Takashi 
Published: September 2022

Abstract
Recently, effectiveness of robot-assisted minimally invasive esophagectomy (RAMIE) has been reported however, there are some issues specific to RAMIE which may lead to major complications. The issues include 1) interference with the right shoulder, 2) compression of vertebral bodies and blood vessels, 3) energy devices, and 4) education to young surgeons. In this study, we evaluated the short-term outcome of RAMIE in our department, and show the ideas for improving those issues.
For 1), the assistant gives instructions to the surgeon, and uses a protector on right shoulder. In 2), port arrangement depending on the cases and switching the camera port is useful. 3) Because those devices are still under developing, careful procedure is required while using energy device, 4) Double console and extra thoracoscopic camera is useful in operating under the education. We conducted a comparative study of 81 cases of RAMIE performed at our institution from 2014 to January 2022 and 392 cases of prone thoracoscopic esophagectomy performed at about the same time, to evaluate the short-term outcomes including complications.
RAMIE showed an increase in thoracic operation time (median 286 min vs 260 min), but amount of thoracic bleeding tended to be smaller (median 13 mL vs 19 mL). Recurrent laryngeal nerve palsy (G1) was about 40%, and pneumonia was about 18%, which was about the same. One case encountered to in-hospital death from RAMIE group by aspiration pneumonia and one cardiac tamponade by thoracoscopic surgery, respectively, Also, there was no difference in short-term outcomes between experienced and non-experienced surgeons, except operation time.
It is difficult to educate young surgeons who cannot afford to pay attention to the surroundings because there is a possibility that the surrounding organs will be damaged without resistance. Therefore, experienced surgeon should observe and understand the situation using double console or an additional scope. Also, many other knacks and tricks are important to reduce the complications arises from robotic surgery.
257. DIFFERENCES IN PERIOPERATIVE STRATEGIES IN ESOPHAGEAL CANCER TREATMENT IN 13 NORDIC UNIVERSITY HOSPITALS CALL FOR HIGH-LEVEL EVIDENCE REGARDING THESE PRACTICES
Authors: Achiam Michael , Nilsson Magnus , Åkesson Oscar , Johansson Jan , Edholm David , Lindblad Mats , Szabo Eva , Sundbom Magnus , Lindberg Fredrik , Larsen Michael Hareskov , Aahlin Eirik Kjus , Mala Tom , Johannessen Hans-Olaf , Johnsen Gjermund , Kauppila Joonas , Löfdahl Per , Hedberg Jakob 
Published: September 2022

Abstract
The Nordic countries have similar health care systems and registries simplifying epidemiological research and the treatment of esophageal cancer is largely centralized. However, differences in treatment traditions can hamper the possibility to assess results and harmonize control arms in joint randomized trials. In setting up a Nordic multi-center randomized trial regarding the use of nasogastric tube (NG-tube) decompression, we aimed to investigate differences in perioperative routines after esophageal resection at Nordic University hospitals.
All Nordic University Hospitals with an upper gastrointestinal cancer center (UGC) were contacted regarding a Nordic randomized controlled trial exploring the effects and complications associated with the use of NG-tube after esophagectomy for cancer. Those who chose to join the trial were sent a questionnaire regarding surgical volumes and practices including mean annual number of esophagectomies, surgical method/access, and routine use of pyloric drainage and jejunostomy. In addition, the current standard postoperative use of NG-tube and routine X-ray/CT evaluation, along with postoperative traditions regarding the start of liquid diet was enquired. High volume centers were defined as performing &gt;20 procedures/year.
Thirteen of 17 centers with a combined catchment area of 16 million inhabitants and an annual volume of 445 esophagectomies joined the trial network. All, but one center used a total minimally invasive- or hybrid surgical approach but otherwise, the routine use of pyloric drainage and jejunostomy varied widely without being statistically different. All 13 centers reported routine use of NG-tube and 4 employed continuous suction. The NG-tube was removed between 3 and 7 days postoperatively, but also strategies between the centers (suction on NG-tube, start of liquid diet, routine X-ray/CT evaluation) varied without being statistically significant
Firm adherence to standardized operations and safety protocols are implemented in Nordic UGCs to reduce the potential consequences of complications. However, the results find the differences in perioperative care after esophagectomy apparent, highlighting the need for high-level evidence regarding these practices. A unified approach may facilitate clinical trial initiatives. There is a paucity of evidence regarding optimal NG-tube use after esophagectomy for cancer and a randomized trial (kiNETiC ISRCTN39935085) investigating this issue is underway.
259. COMPARISON OF GREATER CURVATURE AND LESSER CURVATURE CIRCULAR-STAPLED ESOPHAGOGASTROSTOMY AFTER ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Authors: Sasaki Ken , Tsuruda Yusuke , Shimonosono Masataka , Noda Masahiro , Uchikado Yauto , Tada Nobuhiro , Okumura Hiroshi , Omoto Itaru , Natsugoe Shoji 
Published: September 2022

Abstract
Using a circular stapler to create an anastomosis for esophagogastrostomy after esophagectomy is well accepted; however, it remains uncertain if the greater curvature (GC) or lesser curvature (LC) of the gastric conduit is better for the anastomosis. We conducted this prospective study to compare the integrity of esophagogastrostomy between the esophagus and the GC or LC side of the gastric conduit.
The subjects of this study were 70 patients who underwent esophagectomy and were randomized to a ‘GC’ group and an ‘LC’ group (n = 35 each). The primary and secondary end points were anastomotic leakage (AL) and anastomotic stricture (AS), respectively.
The overall AL rate was 22.1%, without a significant difference between the groups. Stump leakage developed in eight of nine patients in the GC group, whereas leakage developed at the esophagogastric anastomosis in five of six patients in the LC group. The rate of stump leakage was significantly higher than that of esophagogastric AL in the GC group. The overall AS rate was 4.4%, with a significant difference between the groups (0% in the GC group vs. 9.1% in the LC group).
AL rates were comparable in the two groups, but the sites of leakage were significantly different.
260. EFFECT OF ENDOLUMINAL VACUUM THERAPY ON THE PERFUSION OF GASTRIC CONDUIT IN A PORCINE MODEL FOR ESOPHAGECTOMY
Authors: Felinska Eleni , Studier-Fischer Alexander , Wise Philipp Anthony , Özdemir Berkin , Chen Zi-We , Willuth Estelle , Allers Michael , Müller-Stich Beat , Nickel Felix 
Published: September 2022

Abstract
After esophagectomy, the postoperative rate of anastomotic leakage is between 5 and 30% and is the main driver of morbidity and mortality. Complication management is often based on endoluminal vacuum therapy (EndoVAC) with good success rates. Vacuum therapy has been shown to improve tissue perfusion in superficial wounds but this has not been shown for gastric conduits. The present study aimed to assess changes in gastric conduit perfusion in a porcine model for esophagectomy.
Porcine model (n = 18) underwent gastric conduit formation and induction of partial conduit ischemia. In three experimental groups EndoVAC therapy was used in the gastric conduit (−40 mmHg, −125 mmHg and − 200 mmHg) with continuous suction. The changes in tissue perfusion and edema were assessed using hyperspectral imaging (HSI).
During EndoVAC treatment with −125 mmHg a significant and stable increase in the oxygenation index from 44.9 ± 7.6% to 61.9 ± 5.5% and 62.9 ± 9.4%. (p = 0.02) was seen after 60 minutes and 120 minutes respectively. A similar trend was seen during EndoVAC treatment with −200 mmHg. There was a non-significant increase in tissue oxygenation during treatment with −40 mmHg. A significant increase of tissue water content from 40.8 ± 7.4 to 59.5 ± 10.3 (p = 0.004) was observed after 60 minutes of EndoVAC therapy with −200 mmHg. There were no significant differences in tissue water content during EndoVAC therapy with −40 mmHg and − 125 mmHg.
EndoVAC treatment with a pressure of at least −125 mmHg significantly increases perfusion of partial ischemic gastric conduit. With better understanding of underlying physiology, the optimal use of EndoVac treatment can be guided and determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion. This can potentially be translated into clinical practice.
267. CURRENT STATUS OF COMPREHENSIVE GENOME PROFILING FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yamamoto Shun , Koyama Takafumi , Hirose Toshiharu , Ohara Akihiro , Itoyama Mai , Yokoyama Kazuki , Honma Yoshitaka , Kato Ken 
Published: September 2022

Abstract
Esophageal squamous cell carcinoma (ESCC) is the dominant histological subtype of esophageal cancer in Japan. However, there are few effective drugs for advanced ESCC patients (pts), and the prognosis of advanced ESCC pts remains poor. In 2019, comprehensive genome profiling (CGP) tests were approved for patients with advanced solid cancers who were refractory or intolerant to standard treatments. However, there were little data on CGP tests for advanced ESCC patients.
The subjects were advanced ESCC patients received CGP tests between June 2019 and February 2022 and expected to be refractory or intolerant to standard treatments. This study evaluated characteristics of advanced ESCC patients who received CGP tests and the clinical utility of CGP tests to receive investigational new drugs.
Characteristics of 12 patients were follows; median age:61(range: 48–72), male/female:10(83.3%)/2(16.7%)pts, performance status 0/1/2:2(16.7%)/9(75.0%)/1(8.3%)pts, treatment line 2/3/4:3(25.0%)/8(66.7%)/1(8.3%)pts CGP tests FoundationOne CDx/OncoGuideTM NCC Oncopanel System:8(66.7%)/4(33.3%)pts. All pts(100%) and 7pts(58.3%), 5pts(41.7%), 4pts(33.3%), 2pts(16.7%) showed TP53 mutations and CDKN2A/B loss, FGF amplification, NFE2L2 mutations, TMB-high. Seven pts(58.3%) were candidates for investigational new drugs based on CGP, 1 pt(8.3%) received investigational treatment based on CGP (ERBB2 amplification), 1 pt(8.3%) received investigational treatment not based on CGP test. 5pts(41.7%) were ineligible to trials according to deteriorated general condition or prior treatments. In 5pts(41.7%) without druggable gene alteration based on CGP tests, 2pts(16.7%) received investigational treatments not based on CGP.
This study clarified the current status of CGP tests for advanced ESCC patients in our hospital. Due to the small population, further investigation was needed to evaluate the utility of CGP for ESCC pts.
272. IMPLEMENTATION OF AN ERAS PROTOCOL IN PATIENTS UNDERGOING ESOPHAGECTOMY: EVALUATION OF THE RESULTS
Authors: de Zadava Lissón Miriam Menéndez Jiménez , Esteban Marcos Bruna , Navarro Fernando Mingol , Urbaneja Francisco Javier Vaqué , Pardo Luis Hurtado , García Alberto Sánchez 
Published: September 2022

Abstract
Esophagectomy is a complex surgery and has classically been a surgery with high morbidity and mortality and high hospital stay. The implementation of ERAS protocols in esophageal surgery is lagging behind other digestive surgeries due to its complexity, but little by little ERAS protocols are starting to be implemented in high volume units.
Retrospective and descriptive analysis of 50 patients undergoing elective McKeown esophagectomy (April 2018–December 2021).
The ERAS protocol starts with prehabilitation. Unless contraindicated, they receive an epidural catheter and a minimally invasive approach; no abdominal or cervical drains, decompressive nasogastric tube or feeding jejunostomy are left in place unless risk of malnutrition. From the first postoperative day they begin to sit up and start respiratory and motor rehabilitation; after leaving the ICU, they begin to deambulate and the bladder catheter is removed.
The descriptive study used median and interquartile range (IQR) for quantitative variables and percentage of cases for qualitative variables.
A total of 50 patients were analysed.
The 70% were men, median age was 64,50 years (55,75–71), BMI 23.20 (20,9-26,3). The 20% were diabetic, 28% were bronchopathic and 14% had some type of heart disease. The 54% had an ASA ≥3. The etiology was neoplasic in 90% and 10% due to stenosis after caustic ingestion; 79,7% received neoadjuvant treatment. Feeding jejunostomy was performed in 42%, abdominal drainage was placed in 18% and thoracic drainage in 50%. The epidural catheter was removed on the 3rd day (2,25-5,75). Table 1 shows the postoperative results.
The implementation of an ERAS protocol in esophageal surgery is necessary and feasible with good results, without an increase in morbimortality and with a decrease in hospital stay and an improvement in patient comfort.