bluuebunny/crossref_metadata_2025_split huggingface dataset:
320. EFFICACY OF LAPAROSCOPIC FUNDOPLICATION IN PATIENTS WITH CHRONIC COUGH AND GASTRO-OESOPHAGEAL REFLUX
Authors: Frankel Adam , Ong Hock Soo , Nathanson Lesley , Smithers B Mark , Martin Ian , Gotley David 
Published: September 2022

Abstract
The outcome of anti-reflux surgery in patients with cough suspected to be induced by gastro-oesophageal reflux disease is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication (LF) for controlling cough in a patient population suffering chronic cough when alternative aetiologies (e.g. asthma) had been excluded and pathologic gastro-oesophageal reflux had been confirmed on ambulatory pH monitoring, and to identify predictors of response.
From a prospective database of 1,598 patients who had undergone laparoscopic fundoplication, 66 (4%) had a principal presenting symptom of chronic cough as well as objective evidence of gastro-oesophageal reflux disease (GORD). Patients completed questionnaires for GORD symptoms (modified DeMeester score) and severity of cough (visual analog scale) both before and after LF, and had pre-operative gastroscopy and 24-hour pH monitoring before operation. Patients were considered to have responded to LF if they had no cough or the cough had improved by 50% or more after operation.
Follow-up data was available for 66/66 patients (100%), with a median follow-up time of 43 months (range 14–104 months) after operation. Cough was relieved in 40/66 (61%), while typical GORD symptoms (heartburn, regurgitation) was relieved in 44/49 (90%). The presence of typical GORD symptoms, oesophagitis, or pH study variables did not predict the response of the cough to LF. At 1 year, 67% of patients were satisfied with the results of their surgery, 20% were not and 13% were unsure. For comparison, the 1430/1598 patients in the database with no laryngopharyngeal symptoms had a satisfaction rate of 94%.
Based on our study and available literature, it appears there are no reliable pre-operative clinical predictors of a satisfactory response of cough to LF. This probably reflects a current inability to obtain an accurate aetiological diagnosis of chronic cough, even in the presence of known abnormal gastro-oesophageal reflux disease. Regardless, in a well-chosen cohort of patients with chronic cough, LF can yield good patient satisfaction rates, albeit less than for patients with typical GORD symptoms.
323. CLINICAL CHARACTERISTICS OF HIATAL HERNIA WITH ANEMIA AND SIGNIFICANCE OF SURGICAL REPAIR
Authors: Nakanishi Yasutaka , Hata Hiroaki , Suenaga Takahiro , Moriyama Masaaki , Degawa Kanako , Kojima Hiroya , Kanbe Hiroyuki , Miki Akimori , Nakanishi Hiroki , Yamaoka Ryoya , Matsusue Ryo , Narita Masato , Otani Tetsushi , Yamaguchi Takashi 
Published: September 2022

Abstract
Most patients with hiatal hernia (HH) are asymptomatic. However, HH may provoke severe gastroesophageal reflex, anorexia, and anemia. Therefore, therapeutic indication and approach are controversial especially for elderly and frail patients. So, we investigated clinical features of HH with anemia and treatment outcome of surgical repair.
From Jan. 2010 to Sep. 2021, 97 patients diagnosed HH by upper gastrointestinal scope and/or computed tomography and were taken blood test at the same time. Patients with malignant disease and after gastrectomy were excluded in this research. We examined the correlation between anemia and clinical characteristics (symptoms, physical and morphological factors) retrospectively. Similarly, hemoglobin(HGB) status after surgical repair were investigated.
HGB of 21 cases (21.6%) represented less than 10 g/dl at the time of diagnosis. Elderly (p = 0.0007), disorders of the spine (kyphosis and scoliosis) (p = 0.006), typeIV hiatal hernia (p = 0.02), GERD (Grade ≥ A) (p = 0.07) were correlated with anemic cases of HH, which were consistent with clinical characteristic of giant hiatal hernia (GHH).
In GHH (47 cases) with more than 30% stomach bulges into mediastinum, HGB of 17 cases (36%) represented less than 8 g/dl, and 9 cases (19%) were required blood transfusion. Six cases (13%) of GHH underwent surgical repair, and no exacerbation of anemia was observed after surgery.
Elderly, kyphosis/scoliosis, and GHH were represented as the features of HH with anemia. Severe anemia is common symptom in GHH cases, and surgical repair might improve anemia in operable cases.
324. CLINICAL OUTCOME OF CURATIVE SURGERY AND DEFINITIVE CHEMORADIOTHERAPY FOR PATIENTS WITH RESECTABLE CERVICAL ESOPHAGEAL CANCER
Authors: Inoue Masazumi , Tsubosa Yasuhiro , Haneda Ryoma , Mayanagi Syuhei , Ishii Kenjiro 
Published: September 2022

Abstract
Esophagectomy and definitive chemoradiotherapy are standard initial treatment modality for resectable cervical esophageal cancer. We compared the treatment results of both treatment methods and examined treatment strategies for resectable cervical esophageal cancer.
Patients who were treated for resectable cervical esophageal cancer at our hospital from January 2003 to March 2017 were divided into surgery group and chemoradiation therapy group (CRT group) for the initial treatment. The treatment results were compared retrospectively.
Of all 51 patients, 20 patients received surgery and 31 received CRT. In surgery group, 16 cases lost their laryngeal function by surgery. Recurrence was observed in 7 cases, of which only 1 case was local. In CRT group, 26 cases (83.9%) achieved complete response, of which 13 cases relapsed. 5-year laryngeal-preserving survival rate was 56.2% in CRT group, and 72.3% for non-stenotic patients. There was no significant difference in 5-year survival rate between two groups (surgery, 62.2%; CRT, 66.1; p = 0.648). In stenotic cases, 5-year survival rate was better in surgery group (surgery, 75 0.0%; CRT, 25.0%; p = 0.033).
The local control of the primary lesion and the prognosis in the stenotic cases were better in the surgery group. On the other hand, the 5-year laryngeal-preserving survival rate of the CRT group was high in non-stenotic cases. These results can be an important factor in choosing initial treatment for resectable cervical esophageal cancer.
326. REDUCTION OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH RETROSTERNAL GASTRIC TUBE RECONSTRUCTION
Authors: Okumura Tomoyuki , Miwa Takeshi , Numata Yoshihisa , Watanabe Toru , Hirano Katsuhisa , Igarashi Takamichi , Tanaka Haruyoshi , Hashimoto Isaya , Shibuya Kazuto , Hojo Shozo , Yoshioka Isaku , Fujii Tsutomu 
Published: September 2022

Abstract
Anastomotic leakage (AL) after esophagectomy is one of the major complications after esophagectomy.
The aim of this study was to evaluate anastomotic procedure to reduce AL after esophagectomy with retrosternal gastric pull up.
A total of 157 consecutive patients underwent thoracoscopic esophagectomy followed by retrosternal reconstruction with gastric tube in our hospital between January 2008 and December 2021. The anastomotic procedure was revised at January 2016. After cervical esophagogastric anastomosis using circular stapler, gastric tube was pulled down to linearize and place the anastomotic site below the suprasternal notch (SN). The sternum tracheal distance (STD) and the level of esophagogastric anastomosis (LEA) were measured using CT image.
In comparison between the former (-December 2015, 65 cases) and later (January 2016-, 92 cases) group, AL was significantly reduced from 11/65 (16.9%) to 0/92 (0%) cases (p &lt; 0.001). LEA was significantly lower in the later group than former group (2.7 mm below SN vs 25 mm above SN; p &lt; 0.001). No difference was observed in the clinicopathological characteristics. In comparison between the cases with and without AL (11/146 cases), significant difference was seen in BMI (average 24.4/21.6, p&lt;0.01) and LEA (average 23.5/8.0 mm, p = 0.02). Multivariate analysis revealed that BMI (21.5&gt;, p = 0.02) and LEA (0&gt;, p &lt; 0.01) were the independent factors associated to AL.
Surgical procedure which avoids excessive compression on the gastric tube at the thoracic inlet may take an important role in reduction of AL.
328. MOLECULAR SUBTYPING OF ESOPHAGEAL ADENOCARCINOMA BY NON-NEGATIVE MATRIX FACTORIZATION OF LASER CAPTURE MICRODISSECTED RNA-SEQ SAMPLES
Authors: Wilson Gavin , Mathew Elizabath , Shibahara Yukiko , Allison Frances , Bach Yvonne , Allen Jonathan , Kalimuthu Sangeetha N , Elimova Elena , Darling Gail , Yeung Jonathan 
Published: September 2022

Abstract
Previous attempts to construct prognostic molecular subtypes for esophageal adenocarcinoma (EAC) using gene expression profiling has met with little success when compared to adenocarcinomas from other disease sites. We hypothesized that this is in part due to the low tumour cellularity obtained from EAC biopsy and resection specimens, which obscures the tumour-intrinsic gene expression signals due to normal cell contamination.
We systematically collected biopsies from pre-treatment, post-induction, and metastatic EAC tumors. Laser capture microdissection (LCM) was utilized to enrich for tumour cells for whole transcriptome sequencing (RNA-seq) (N = 54). We utilized non-negative matrix factorization (NMF) with 7 components to identify common gene expression programs across our samples.
After applying NMF to our samples, we identified 4 tumour-intrinsic components and 3 tumour-extrinsic components (including immune infiltrate and normal esophagus). These components validated on TCGA EAC and esophageal squamous cell carcinoma RNA-seq, single cell RNA-seq from EAC organoids, and the cancer cell line encyclopedia. Moreover, we observed that these tumour-intrinsic gene expression programs were preserved in EAC samples metastatic to other organ sites such as liver and lymph nodes. We observed that most tumours expressed more than one tumour component and that approximately 25% of our samples had low tumour signals despite LCM enrichment.
We used LCM to enrich for tumour signal in EAC gene expression profiling data and identified 4 tumour-intrinsic gene expression programs that validate across multiple datasets. We have currently conducting survival analysis on our data and TCGA data to further validate the prognostic potential of our tumour signatures.
329. IMPROVED TUMOUR PURITY AND PLOIDY ESTIMATION FROM LASER CAPTURE MICRODISSECTED ESOPHAGEAL ADENOCARCINOMA SAMPLES
Authors: Wilson Gavin , Mathew Elizabath , Shibahara Yukiko , Allison Frances , Bach Yvonne , Allen Jonathan , Akhter Akhi , Shathasivam Premalatha , Kalimuthu Sangeetha N , Elimova Elena , Darling Gail , Yeung Jonathan 
Published: September 2022

Abstract
Large scale sequencing efforts by The Cancer Genome Atlas (TCGA), among others, have generated detailed genomic data for esophageal adenocarcinoma. However, samples with low cancer purity (i.e. high amounts of normal DNA) will limit accurate inference of copy number aberrations, a genomic hallmark of esophageal adenocarcinoma. This consequently restricts more advanced analysis such as quantifying intratumor heterogeneity or inferring tumor evolution.
We have systematically collected biopsies from pre-treatment and post-induction esophageal adenocarcinoma tumors. Laser capture microdissection (LCM) was utilized to enrich for tumor cells for whole genome sequencing. Matching blood was utilized as germline control. Cancer purity and ploidy was estimated using a developed method tailored to the high genomic instability observed in EAC samples. This method uses both sequencing depth and minor allele frequencies to infer ploidy and purity. The esophageal adenocarcinoma dataset from TCGA were used as comparison.
We achieved significantly higher tumor cellularity in surgical resection specimens (n = 8) compared to TCGA (71%+/−11 vs. 58%+/−18). Interestingly, tumor cellularity from biopsy specimens (n = 25) remained similar to TCGA despite LCM (65%+/−13), which is likely due to TCGA only using surgical resections that were pre-selected to have at least 60% cellularity, while we applied no histopathological cellular constraints on our samples. Estimated ploidy was similar between biopsy of primary tumors and surgical resection specimens compared to TCGA (2.67+/−0.58, 2.72+/−0.70, 2.64+/−0.75). There was a trend towards higher ploidy (3.07+/− 0.13) in metastatic biopsies (n = 3) but additional specimens are required.
Laser capture microdissection of post-induction esophageal adenocarcinoma surgical resection specimens has resulted in significantly higher tumor purity in whole genome sequencing data. This will allow for improved inferences of phylogenetic trees between pre- and post- induction samples and quantification of subclonal copy number aberrations or intratumor heterogeneity.
334. DEFINITION OF SEVERE BENIGN OESOPHAGEAL STRICTURES AND IDENTIFICATION OF ASSOCIATED RISK FACTORS
Authors: Elbe Peter , Boytsova Anna , Lindblad Mats , Klevebro Fredrik , Vujasinovic Miroslav 
Published: September 2022

Abstract
Benign oesophageal strictures (BES) are often easily treated but around 30% progress into recurrent or refractory benign oesophageal strictures (RBES), that need repetitive dilatations. Difficulties of RBES have been widely discussed in the literature, but there is not a well-established consensus regarding the definition of RBES. In this study we wanted to develop a simple definition in relation to aetiology and number of dilatation sessions per stricture.
A retrospective study on 242 BES-patients treated with endoscopic dilatation was performed. The primary endpoint was need of further dilatation per procedure, based on total number of dilatation sessions performed and stricture ethology. Univariate and multivariable regression analysis were performed to assess risk factors for RBES.
Among 242 patients, 76 had RBES. The need of further dilatation increases with 13% at fifth dilation session and keeps a continuous mean value at 81%. Investigating some aetiologies separately, the point where need increases does vary. The risk of having RBES decreased for distal (Odds Ratio (OR) 0,25 (Confidence interval (CI) 95% 0,09-0,65)) and middle (OR 0,35 (CI 95% 0,13-0,88)) location of the stricture compared to proximal strictures.
We propose that a stricture can be defined as RBES when reaching the fifth dilatation session. At that point we also suggest that clinicians should consider additional treatment, in addition to dilatation, in order to resolve the stricture.
342. GENOMIC ANALYSIS OF RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA
Authors: Breininger Stella P , Izadi Fereshteh , Sharpe Ben , Secrier Maria , Gibson Jane , Walker Robert , Rahman Saqib , Devonshire Ginny , Lloyd Megan , Walters Zoë , Fitzgerald Rebecca , Rose-Zerilli Matthew , Underwood Tim 
Published: September 2022

Abstract
Oesophageal adenocarcinoma (OAC) is the ninth most common cancer worldwide, with a mortality of &gt;500,000 deaths yearly. Neoadjuvant chemotherapy (NAC) followed by surgery is the standard of care (SOC) for locally advanced OAC. Although almost all patients receive chemotherapy as SOC, but &lt;20% respond and benefit from chemotherapy before surgery. The OAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns may result in chemotherapy sensitivity or resistance.
To identify associations between genomic events and response to NAC in OAC, a comparative genomic analysis was performed in 65 patients using whole-genome sequencing. We defined response to NAC using Mandard Tumour Regression Grade TRG), with responders classified as TRG1–2 (n = 27) and non-responders classified as TRG4–5 (n = 38).
We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs 1.70/Mb, P = 0.036) and elevated copy number variation (CNV) in non-responders (282 vs 136/patient, P &lt; 0.001). We identified CNVs unique to each group, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of particular interest was the identification of the Neuron Navigator-3 (NAV3), a known tumour suppressor downstream of EGFR, which was mutated exclusively in 22% of non-responders.
Our work characterises genetic features and mutations that are uniquely associated with response to NAC. We envision a treatment pipeline that incorporates driver mutation profiling in OAC, combining response prediction with targeted therapies to enhance response to NAC and improve survival outcomes.
345. CAMRELIZUMAB AS ADJUVANT THERAPY IN RESECTED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PHASE 2 TRIAL
Authors: Meng Xiangrui , Shan Zhengzheg , Xu Mengli , Lu Yao , Guan Lulu , Chen Yu , Wang Huike , Yang Yuanyuan , Chi Yanyan , Yang Yalan , Fan Qingxia , Wang Feng 
Published: September 2022

Abstract
CheckMate 577 has confirmed that adjuvant immunotherapy significantly prolongs disease-free survival (DFS) in patients with resected (R0) stage II or III esophageal or gastroesophageal junction cancer who had received neoadjuvant chemoradiotherapy. However, adjuvant therapy for patients with different neoadjuvant therapies needs to be explored. Therefore, this study was designed to investigate the efficacy and safety of camrelizumab as adjuvant therapy in patients with resected (R0) esophageal squamous cell carcinoma (ESCC).
This is an ongoing, non-randomized, open-label, phase 2 trial (NCT04533490) in China. ESCC patients (stage cT1b-T4aN0M0/cT1-T4aN + M0) aged 18–75 years with ECOG performance status of 0–1 was planned to be enrolled in cohort A (n = 42, with 6–12 weeks of neoadjuvant therapy) and cohort B (n = 43, without neoadjuvant therapy). Following R0 resection, adjuvant camrelizumab (200 mg Q2W) was given until tumor recurrence, metastasis, intolerable toxicity, or the completion of 12-month treatment. The primary endpoint was DFS. Secondary endpoints included overall survival, recurrence rate, 1/3/5-year DFS rates, and safety.
At data cutoff (Apr 21, 2022), 17 patients were enrolled, with a median age of 65 years; 9 (53%) patients were males, and 12 (71%) had ECOG performance status of 0. There were 15 patients in cohort A (14 with neoadjuvant immunochemotherapy, and 1 with neoadjuvant chemotherapy) and 2 in cohort B. With a median follow-up of 5.5 months, DFS was not reached. A total of 14 (82.3%) patients had treatment-related adverse events, which were all grade 1–2. The most common events were reactive cutaneous capillary endothelial proliferation (11 [65%]), adrenal cortical insufficiency (3 [18%]), and interstitial pneumonia (2 [12%]).
Adjuvant camrelizumab showed acceptable safety profile in patients with resected (R0) ESCC who mainly received neoadjuvant immunochemotherapy, and the efficacy was worth expecting. The study enrollment is ongoing, and further survival and safety data will be reported in the future.
351. SUPERIOR MEDIASTINAL DISSECTION DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER—A MULTICENTER PROPENSITY SCORE MATCHED (PSM) ANALYSIS
Authors: Yip Hon Chi , Lam Dennis Chin Tou , So Rain Choi Kwan , Fung Michelle Hei Wai , Ng Stephen Ka Kei , Chan Shannon Melissa , Teoh Anthony Yuen Bun , Ng Enders Kwok Wai , Chiu Philip Wai Yan 
Published: September 2022

Abstract
Minimally invasive esophagectomy (MIE) is currently the preferred approach of surgery for esophageal cancer. Systematic superior mediastinal lymphadendectomy along bilateral recurrent laryngeal nerve is enhanced by the magnified view in thoracoscopy, and is increasingly performed to achieve complete nodal dissection. Both participating centers began MIE with systematic superior mediastinal dissection in recent 5 years. In the current study, we aim to compare the short- and medium-term outcomes of MIE with or without superior mediastinal dissection.
Consecutive patients who received MIE for esophageal cancers from 2004 to 2021 were recruited, data were collected from a prospectively maintained database. Patients were divided into ‘systematic superior mediastinal dissection’ and ‘control’ groups, and propensity score matching was performed with age, tumor location, tumor stage and neoadjuvant therapy. Total 157 patients were recruited, 67 (42.7%) in the extended superior mediastinal dissection group. After PSM, 48 patients were identified in each group. Short term surgical outcomes as well as medium term survival results were compared.
Operative time was significantly longer with extended superior mediastinal dissection. Higher number of lymph nodes were yielded in total and from the superior mediastinum. Recurrent laryngeal nerve palsy developed in 52.1% and 43.8% of the MIE with or without extended dissection respectively, but significantly fewer palsies required intervention in the extended dissection group. Higher rate of anastomotic leakage was observed in the extended dissection group, but there was no difference in the overall severe adverse event (&gt; = Grade III: 31.3% vs 35.4%). There was no statistical difference in the survival, but a trend towards improved 2 year disease-free survival was observed.
Minimally invasive esophagectomy with systematic superior mediastinal dissection achieved a higher lymph node yield and a trend towards improved disease free survival. The overall adverse event rate was similar with conventional dissection. While better cancer staging could be achieved with extended dissection, further research is required to confirm the oncological benefit of extended dissection.
352. ENDOSCOPIC SCORING SYSTEM FOR ACHALASIA PRE AND POST LOWER ESOPHAGEAL SPHINCTER INTERVENTION: THE DELAYED ESOPHAGEAL CLEARANCE IN ACHALASIA (DECA) SCORE
Authors: Ellison Ashton , Nguyen Anh D , Podgaetz Eitan , “Shan" Reddy Chanakyaram , Souza Rhonda F , Spechler Stuart J , Konda Vani JA 
Published: September 2022

Abstract
While esophageal high-resolution manometry (HRM) is the gold standard test to diagnose achalasia, endoscopy findings can demonstrate impaired esophageal clearance. Presently, there is no standardized method to describe the severity of these findings. We developed a novel scoring system, the Delayed Esophageal Clearance in Achalasia (DECA) score, to describe achalasia findings on endoscopy. In this study, we seek to demonstrate that DECA scores, an objective marker of esophageal clearance, improve after peroral endoscopic myotomy (POEM).
We reviewed the Baylor Scott and White Center for Esophageal Diseases patient database for patients who had both HRM and endoscopy performed between December 2020 and April 2021. Each patient had a DECA endoscopic score calculated based on four endoscopic findings at the time of endoscopy (Table 1). The medical records of patients who underwent a POEM with pre- and post- DECA scores between December 2020 to November 2021 were also reviewed. Patients with suspected or known achalasia were on a 1–5 day liquid diet prior to their endoscopic procedure.
Among 254 patients in our database, 165 patients had no prior foregut surgery. Of the 165 surgical-naïve patients, 72 had an abnormal EGJ complex (EGJOO = 58, achalasia type 1 = 2, type 2 = 7, and type 3 = 5) with a mean DECA score of 5.9 (SD 2.4) in those with achalasia and 2.2 (SD 1.6) in EGJOO. There were 17 patients who underwent a POEM with a mean pre-POEM DECA score of 8.7 (SD 2.2) and a mean post-POEM DECA score of 3.2 (SD 2.2). The reduction in DECA score after POEM was statistically significant (p = &lt;0.001).
The DECA scoring system can be easily calculated at the time of endoscopy and allows for a standardized language in describing achalasia endoscopic finding especially in the pre- and post-treatment endoscopic assessment. In our study, we found a statistically significant difference in DECA score in patients pre and post POEM intervention.