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Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus最新文献

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Editorial: Role of thoracic duct ligation in esophagectomy. 评论:胸导管结扎在食管切除术中的作用。
C L Donohoe
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引用次数: 0
What is the significance of the Hill classification? 希尔分类法的意义是什么?
Lisa Brännström, Mårten Werner, Bengt Wallner, Karl A Franklin, Pontus Karling

This study aimed to investigate the significance of Hill classification to predict esophagitis, Barrett's esophagus, gastroesophageal reflux disease (GERD) symptomatology, and future prescriptions of proton pump inhibitors in clinical practice. A total of 922 patients (546 women and 376 men; mean age 54.3 [SD 18.4] years) who underwent gastroscopy between 2012 and 2015 were analyzed. Patient questionnaire regarding symptoms were compared with endoscopy findings. A medical chart review was done that focused on the prescription of PPIs, additional gastroscopies, and GERD surgery in a 3-year period before the index gastroscopy and in a 6-year period afterward. In patients naïve to PPI prescriptions (n = 466), Hill grade III was significantly associated with esophagitis (AOR 2.20; 95% CI 1.00-4.84) and > 2 PPI prescriptions 6 year after the index gastroscopy (AOR 1.95; 95% CI 1.01-3.75), whereas Hill grade IV was significantly associated with esophagitis (AOR 4.41; 95% CI 1.92-10.1), with Barrett's esophagus (AOR 12.7; 95% CI 1.45-112), with reported heartburn (AOR 2.28; 95% CI 1.10-4.74), and with >2 PPI prescriptions (AOR 2.16; 95% CI 1.02-4.55). In patients 'non-naïve' to PPI prescription (n = 556), only Hill grade IV was significantly associated with esophagitis, reported heartburn, and with >2 PPI prescriptions. The gastroscopic classification in Hill grades III and IV is important in clinical practice because they are associated with esophagitis, Barrett's esophagus, symptoms of GERD, and prescriptions of PPIs, whereas a differentiation between Hill grades I and II is not.

本研究旨在探讨Hill分型对食管炎、Barrett食管、胃食管反流病(GERD)症状的预测及未来质子泵抑制剂处方的临床意义。共922例患者(女性546例,男性376例;平均年龄54.3 [SD 18.4]岁),于2012年至2015年间接受胃镜检查。将患者的症状问卷与内窥镜检查结果进行比较。我们进行了一项医疗图表回顾,重点是在指数胃镜检查前的3年期间和之后的6年期间,PPIs的处方、额外的胃镜检查和反流手术。在PPI处方naïve的患者中(n = 466), Hill III级与食管炎显著相关(AOR 2.20;95% CI 1.00-4.84),且在指数胃镜检查后6年开具了> 2张PPI处方(AOR 1.95;95% CI 1.01-3.75),而Hill IV级与食管炎显著相关(AOR 4.41;95% CI 1.92-10.1), Barrett食管(AOR 12.7;95% CI 1.45-112),报告有胃灼热(AOR 2.28;95% CI 1.10-4.74),且有>2个PPI处方(AOR 2.16;95% ci 1.02-4.55)。在“non-naïve”到PPI处方的患者(n = 556)中,只有Hill IV级与食管炎、胃灼热和>2个PPI处方显著相关。Hill III级和IV级的胃镜分级在临床实践中很重要,因为它们与食管炎、Barrett食管、GERD症状和PPIs处方有关,而Hill I级和II级之间的区分则不重要。
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引用次数: 0
Early outcomes following EndoFLIP-tailored peroral endoscopic myotomy (POEM): the establishment of POEM services in two UK centers. endoflip定制的经口内窥镜肌切开术(POEM)的早期结果:在英国的两个中心建立了POEM服务。
William Knight, Kaveetha Kandiah, Zoi Vrakopoulou, Annabel White, Lavinia Barbieri, Nilanjana Tewari, Jennifer Couch, Francesco DiMaggio, Mark Barley, Krish Ragunath, James Catton, Abraham Botha

Peroral endoscopic myotomy (POEM) is a safe and effective minimally invasive treatment for achalasia. Postoperative reflux rates remain high. The functional luminal imaging probe (FLIP) allows intraoperative measurement of lower esophageal distensibility during POEM. In theory, this enables a tailoring of myotomies to ensure adequate distensibility while minimizing postoperative reflux risk. Two prospectively collected POEM databases were analyzed from two UK tertiary upper GI centers. The operators in each center used FLIP measurements to ensure adequate myotomy. Outcome measures included Eckardt score (where <3 indicated clinical success) and proton-pump inhibitor use (PPI), collected at the first postoperative appointment. Length of stay was recorded as were complications. In all, 142 patients underwent POEM between 2015 and 2019. Overall, 90% (128/142) had postoperative Eckardt scores of <3 at 6 weeks. Clinical success improved to 93% (66/71) in the latter half of each series with a significantly higher rate of complete symptom resolution (53 versus 26%, P = 0.003). In all, 79% of the poor responders had previous interventions compared with 55% of responders (P = 0.09). Median post-myotomy distensibility index was 4.0 mm2/mmHg in responders and 2.9 in nonresponders (P = 0.16). Myotomy length of <7 cm was associated with 93% clinical success and 40% post op PPI use compared with 60% PPI use with longer myotomies. There were two type IIIa, two type IIIb, and one IV Clavien-Dindo complications. This is the largest series of endoluminal functional lumen imaging probe (EndoFLIP)-tailored POEM in the UK to date. The shorter myotomies, allowed through EndoFLIP tailoring, remained clinically effective at 6 weeks. Complete symptom response rates improved in the latter half of each series. More data will be needed from high-volume collaborations to decipher optimal myotomy profiles based on EndoFLIP parameters.

经口内窥镜下肌切开术(POEM)是一种安全有效的微创治疗贲门失弛缓症的方法。术后反流率仍然很高。功能性腔内成像探头(FLIP)可在POEM术中测量食管下段膨胀性。理论上,这使得裁剪肌切开术,以确保足够的扩张,同时最大限度地减少术后反流风险。两个前瞻性收集的POEM数据库分析了来自英国两个三级上GI中心。每个中心的操作人员使用FLIP测量来确保足够的肌切开术。结果测量包括Eckardt评分(其中
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引用次数: 2
Technical success in performing esophageal high-resolution manometry: a review of competency recommendations, predictors of failure, and alternative techniques. 实施食管高分辨率测压术的技术成功:能力推荐,失败预测因素和替代技术的回顾。
Daniel L Cohen, Haim Shirin

Esophageal high-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders. As this is performed without sedation, it may be poorly tolerated by patients. Additionally, advancing the catheter tip until the stomach may also be difficult, especially if there is a disease affecting the esophagus or esophagogastric junction which may lead to coiling of the catheter. Currently, there are no guidelines as to who can perform HRM. An expert opinion has recommended minimum numbers of cases for the operator to perform in order to obtain and maintain competency. Several studies have reported on the rates of flawed HRM studies with approximately 20% being imperfect, including about 3% with critical flaws. The presence of a large hiatal hernia and achalasia have been identified as predictors of technical failure. Studies with minor flaws are usually still interpretable and clinically useful. Reports have also described several techniques for sedation-assisted placement of the HRM catheter, and this appears to be a promising alternative in cases of failed HRM, especially as sedation does not appear to significantly affect HRM measurements. An algorithm on how to proceed after a technically imperfect HRM study is proposed. Further research in this field is warranted including confirmation of the recommended competency numbers, assessing for quality measures in performing HRM such as technical success rate, identifying additional predictors of technical failure, standardization of the terminology, and qualifying the benefit of sedation-assisted HRM.

食管高分辨率测压(HRM)是诊断食管运动障碍的金标准。由于这是在没有镇静的情况下进行的,患者可能难以耐受。此外,将导管尖端推进到胃也可能是困难的,特别是如果存在影响食道或食管胃交界处的疾病,这可能导致导管盘绕。目前,没有关于谁可以执行人力资源管理的指导方针。一份专家意见建议了操作员为了获得和保持能力而执行的最低数量的案例。几项研究报告了有缺陷的人力资源管理研究的比例,其中约20%是不完美的,其中约3%有严重缺陷。大裂孔疝和贲门失弛缓症的存在被认为是技术失败的预测因素。即使研究有轻微的缺陷,通常仍然是可解释的和临床有用的。报告还描述了几种镇静辅助放置HRM导管的技术,这似乎是在HRM失败的情况下一个有前途的选择,特别是镇静似乎不会显著影响HRM测量。在一个技术上不完善的人力资源管理研究之后,提出了一个算法。在这一领域的进一步研究是有必要的,包括确认推荐的能力数字,评估执行人力资源管理的质量措施,如技术成功率,确定技术故障的额外预测因素,术语的标准化,以及确定镇静辅助人力资源管理的好处。
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引用次数: 2
Correction to: A Consensus Diagnosis Utilizing Surface KI-67 Expression as an Ancillary Marker in Low-Grade Dysplasia Helps Identify Patients at High Risk of Progression to High-Grade Dysplasia and Esophageal Adenocarcinoma. 更正:使用表面KI-67表达作为低级别非典型增生的辅助标志物的共识诊断有助于识别进展为高级别非典型增生和食管腺癌的高风险患者。
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引用次数: 0
Letter to editor in response to 'Risk factors for adverse effects following surgical repair of esophageal atresia. A retrospective cohort study'. 致编辑的信,以回应“食管闭锁手术修复后不良反应的风险因素”。一项回顾性队列研究。
Bilge Gördü, Tutku Soyer
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引用次数: 0
Contemporary outcomes of esophageal and gastroesophageal junction neuroendocrine tumors. 食管和胃食管交界处神经内分泌肿瘤的当代预后。
Lauren M Poston, Shreya Gupta, Christine E Alvarado, Jillian Sinopoli, Leonidas T Vargas, Philip A Linden, Christopher W Towe

Adenocarcinoma and squamous cell esophageal cancers have been extensively studied in the literature. Esophageal neuroendocrine (NET)/carcinoid tumors are less commonly studied and have only been described in small series. The purpose of this study was to describe the demographics and natural history of esophageal NETs, as well as optimal treatments. We hypothesized that surgical resection would be the best treatment of esophageal NETs. The National Cancer Database was used to identify adult patients with esophageal or gastroesophageal junction (GEJ) cancer from 2004 to 2018. Patients were characterized as carcinoid/NET, adenocarcinoma, or squamous cell cancer. Clinical and demographic characteristics were compared between the histology groups. The primary outcome was overall survival, which was assessed by multivariable Cox analysis. Multivariable Cox analysis was also used to analyze factors associated with survival among NET patients who underwent surgery. Among 206,321 patients with esophageal cancer, 1,563 were NETs (<0.01%). Relative to the other two histologies, NETs were associated with younger age, female sex, and advanced clinical stage at diagnosis. Multivariate analysis suggested that NETs were less likely to be treated with surgical resection (OR 0.51, P < 0.001). Nonetheless, surgical resection was associated with improved survival (HR 0.64, P = 0.003). Among patients with NETs who received surgery, neoadjuvant therapy was associated with improved overall survival (HR 0.38, P = 0.013). NET of the esophagus presents with more advanced disease than other common histologies. Among patients with nonmetastatic cancer, surgical resection appears to be the best treatment. Neoadjuvant systemic therapy may offer survival benefit, but future studies are necessary.

腺癌和食管鳞状细胞癌在文献中得到了广泛的研究。食管神经内分泌(NET)/类癌肿瘤的研究较少,仅在小系列中进行了描述。本研究的目的是描述食道NETs的人口统计学和自然历史,以及最佳治疗方法。我们假设手术切除是治疗食管网状肿瘤的最佳方法。国家癌症数据库用于识别2004年至2018年期间患有食管或胃食管交界处(GEJ)癌的成年患者。患者的特征为类癌/NET、腺癌或鳞状细胞癌。比较两组患者的临床和人口学特征。主要终点是总生存期,通过多变量Cox分析评估。多变量Cox分析也用于分析接受手术的NET患者的生存相关因素。在206,321例食管癌患者中,有1,563例NETs (
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引用次数: 1
Acid exposure time is sensitive for detecting gastroesophageal reflux disease and is associated with long-term survival after lung transplant. 酸暴露时间是检测胃食管反流病的敏感指标,与肺移植后的长期生存相关。
Nancy Y Yang, Alice Parish, Shai Posner, Rahul A Shimpi, Richard K Wood, R Thomas Finn, Deborah A Fisher, Matthew G Hartwig, Jacob A Klapper, John Reynolds, Donna Niedzwiecki, David A Leiman

Gastroesophageal reflux disease (GERD) is common in patients who have undergone lung transplantation and is associated with poorer outcomes, but guidelines are lacking to direct management strategies in this population. We assessed the diagnostic yield of impedance metrics compared to pH-metry alone for detecting GERD among lung transplant recipients and evaluated their association with clinical outcomes. We performed a retrospective cohort study of consecutive patients who underwent lung transplantation. Demographic data, acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI), post-reflux swallowing-induced peristaltic wave index (PSPWI), and clinical outcomes including mortality were collected. The relationship between GERD metrics and clinical outcomes was assessed using Wilcoxon signed-rank test and Fisher's exact test as appropriate. Of the 76 patients studied, 29 (38%) had GERD based on abnormal AET after lung transplantation. One (1.3%) patient had GERD based on elevated number of reflux episodes and abnormal distal MNBI detected GERD in 19 (26%) patients, resulting in 62% sensitivity and 94% specificity. Two (2.6%) patients had normal PSPWI. Patients with low distal MNBI had significantly decreased forced expiratory volume in 1 second (FEV1) at 3-year posttransplant compared to those without low distal MNBI (P = 0.03). Three-year survival was significantly worse among patients with elevated AET (66.7% vs. 89.1%, P = 0.03) but not with low distal MNBI (68.4% vs. 84.3%, P = 0.18). Abnormal AET is more sensitive for detecting GERD than other reflux metrics studied and is associated with survival, suggesting pH-metry alone may be sufficient to guide GERD management after lung transplant.

胃食管反流病(GERD)在接受肺移植的患者中很常见,并且与较差的预后相关,但缺乏指导这一人群的治疗策略的指南。在肺移植受者中,我们评估了阻抗法与单独ph法检测胃食管反流的诊断率,并评估了它们与临床结果的相关性。我们对连续接受肺移植的患者进行了回顾性队列研究。收集人口统计学数据、酸暴露时间(AET)、反流发作次数、平均夜间基线阻抗(MNBI)、反流后吞咽诱发的肠波指数(PSPWI)以及包括死亡率在内的临床结果。采用Wilcoxon符号秩检验和Fisher精确检验评估GERD指标与临床结果之间的关系。在研究的76例患者中,29例(38%)因肺移植后AET异常发生胃食管反流。1例(1.3%)患者因反流发作次数增加而出现GERD, 19例(26%)患者的远端MNBI检测到GERD异常,敏感性62%,特异性94%。2例(2.6%)患者PSPWI正常。移植后3年,远端MNBI低的患者1秒用力呼气量(FEV1)明显低于远端MNBI低的患者(P = 0.03)。AET升高患者的三年生存率明显较差(66.7%比89.1%,P = 0.03),但远端MNBI低患者的三年生存率较差(68.4%比84.3%,P = 0.18)。异常AET在检测GERD方面比其他研究的反流指标更敏感,并且与生存率相关,提示单独的ph测定可能足以指导肺移植后GERD的治疗。
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引用次数: 1
ESDE-MIE fellowship: a descriptive analysis of the first experiences. ESDE-MIE奖学金:对第一次经历的描述性分析。
Eider Talavera-Urquijo, Amaia Gantxegi, Giovanni M Garbarino, Giovanni Capovilla, Gijs I van Boxel, Peter P Grimminger, Misha D Luyer, Sheraz R Markar, Lars B Svendsen, Richard van Hillegersberg

Esophageal resection is a high-risk and technically demanding procedure, with a long proficiency-gain curve. The European Society Diseases of the Esophagus (ESDE)-Minimally Invasive Esophagectomy (MIE) training program was launched in 2018 for European surgeons willing to train and to begin a career undertaking MIE. The aim of this study was to evaluate the first experience of the ESDE-MIE fellowship and relate this to the initially predetermined core principles and objectives of the program. Between October 2021 and May 2022, the participating fellows, in collaboration with the ESDE Educational Committee, initiated a survey to assess the outcome and experience of these fellowships. Data from each individual fellowship were analysed and reported in a descriptive manner. Between 2018 and 2022, in total, five fellows have completed the ESDE-MIE fellowship program. Despite the COVID-19 outbreak just the year after its launch, predetermined clinical and research goals were achieved in all cases. Each of the fellows were able to assist in a median of 40 (IQR 27-69) MIE and/or Robot assisted (RA)MIE procedures, of a total median of 115 (IQR 83-123) attended Upper GI cases. After the fellowship, MIE has been fully adopted by the fellows who returned to their home institutions as Upper GI surgeons. The fellowship was concluded by the European Union of Medical Specialists (UEMS) Multidisciplinary Joint Committee (MJC) certification in Upper GI Surgery, which was successfully obtained by all who took part. Based on the experience of the first five fellows, the ESDE-MIE training fellowship meets with the expected needs even despite the COVID-19 outbreak in 2019. Furthermore, these fellows have returned home and integrated MIE into their independent surgical practice, affirming the ability of this program to train the next generation of MIE surgeons, even in the most challenging of circumstances.

食管切除术是一项高风险且技术要求高的手术,具有较长的熟练-获得曲线。欧洲食道疾病协会(ESDE)-微创食管切除术(MIE)培训计划于2018年启动,面向愿意接受培训并开始从事MIE职业的欧洲外科医生。本研究的目的是评估ESDE-MIE奖学金的首次经验,并将其与该计划最初预定的核心原则和目标联系起来。在2021年10月至2022年5月期间,参与的研究员与ESDE教育委员会合作,发起了一项调查,以评估这些研究金的成果和经验。每个研究金的数据都以描述性的方式进行了分析和报告。在2018年至2022年期间,共有5名研究员完成了ESDE-MIE奖学金计划。尽管在启动后仅一年就爆发了COVID-19疫情,但所有病例都实现了预定的临床和研究目标。每位研究员能够协助中位数为40例(IQR 27-69)的MIE和/或机器人辅助(RA)的MIE手术,中位数为115例(IQR 83-123)的上消化道病例。在奖学金结束后,MIE已被返回家乡机构担任上消化道外科医生的研究员完全采用。该研究金由欧洲医学专家联盟(UEMS)多学科联合委员会(MJC)上消化道外科认证,所有参与者都成功获得了该认证。根据前五名研究员的经验,ESDE-MIE培训奖学金即使在2019年爆发COVID-19疫情的情况下也能满足预期需求。此外,这些学员回国后将MIE整合到他们独立的外科实践中,这肯定了该项目培养下一代MIE外科医生的能力,即使在最具挑战性的环境中也是如此。
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引用次数: 0
Letter to the editor: outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center. 致编辑的信:三级护理中心上消化道腐蚀性损伤的治疗结果。
Syed Mahib Ali, Zymal Hamid
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引用次数: 0
期刊
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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