Pub Date : 2024-07-27DOI: 10.1177/26345161241263051
Thomas Andreae, Moustafa Elshafei, James A. Gossage, Thomas Kersting, Reginald Bell
Magnetic sphincter augmentation (MSA) is an alternative treatment option to laparoscopic fundoplication (LF) for patients with gastroesophageal reflux disease. To date, over 40,000 devices have been implanted worldwide since first approval in Europe in 2010 and the USA in 2012. Despite this clinical reality, the long-term safety and effectiveness of the procedure continues to be questioned. This study aims to systematically summarize and appraise the currently available evidence for MSA relative to effectiveness, safety, and healthcare resource use. A systematic literature search was carried out to identify all clinical studies published in English, as of February 15, 2023. Required endpoints were safety, effectiveness, and cost effectiveness. The systematic search identified 212 publications and 14 entries in study registries. After screening and full text analysis, 82 publications were included in qualitative synthesis. One RCT established superiority of MSA compared to twice daily proton-pump inhibitors with respect to the elimination of moderate to severe regurgitation (89% vs 10%, RR 0.11, 95% CI 0.06-0.20, P < 0.001). Eleven cohort studies comparing MSA to LF showed no statistical difference in safety profile and effectiveness measured by post-operative GERD-HRQL score. In addition, patients undergoing MSA significantly retained the ability to belch and vomit when compared to LF. These results were consistent in follow-up out to 7 years. LINX has been shown to provide long lasting relief to patients suffering from persistent GERD while maintaining an acceptable safety profile. As an outpatient day-procedure, MSA is cost effective with short recovery.
{"title":"Current Clinical Evidence for Magnetic Sphincter Augmentation: A Scoping Review","authors":"Thomas Andreae, Moustafa Elshafei, James A. Gossage, Thomas Kersting, Reginald Bell","doi":"10.1177/26345161241263051","DOIUrl":"https://doi.org/10.1177/26345161241263051","url":null,"abstract":"Magnetic sphincter augmentation (MSA) is an alternative treatment option to laparoscopic fundoplication (LF) for patients with gastroesophageal reflux disease. To date, over 40,000 devices have been implanted worldwide since first approval in Europe in 2010 and the USA in 2012. Despite this clinical reality, the long-term safety and effectiveness of the procedure continues to be questioned. This study aims to systematically summarize and appraise the currently available evidence for MSA relative to effectiveness, safety, and healthcare resource use. A systematic literature search was carried out to identify all clinical studies published in English, as of February 15, 2023. Required endpoints were safety, effectiveness, and cost effectiveness. The systematic search identified 212 publications and 14 entries in study registries. After screening and full text analysis, 82 publications were included in qualitative synthesis. One RCT established superiority of MSA compared to twice daily proton-pump inhibitors with respect to the elimination of moderate to severe regurgitation (89% vs 10%, RR 0.11, 95% CI 0.06-0.20, P < 0.001). Eleven cohort studies comparing MSA to LF showed no statistical difference in safety profile and effectiveness measured by post-operative GERD-HRQL score. In addition, patients undergoing MSA significantly retained the ability to belch and vomit when compared to LF. These results were consistent in follow-up out to 7 years. LINX has been shown to provide long lasting relief to patients suffering from persistent GERD while maintaining an acceptable safety profile. As an outpatient day-procedure, MSA is cost effective with short recovery.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.1177/26345161241249384
Jay Shi, Jon O. Wee, Lei Zhao
Verrucous esophageal carcinoma is an extremely rare subtype of squamous cell carcinoma of the esophagus that is characterized by a friable exophytic mass but is often deceptively low-grade and superficially well-differentiated on mucosal biopsies, making pathologic diagnosis challenging. Distant metastasis is rare in these tumors. Therefore, early diagnosis is crucial as surgical resection is frequently curative. Conversely, delay in diagnosis can lead to extensive local invasion and result in severe morbidity and death. In this article, we will outline the history of verrucous esophageal carcinoma, review the current clinical understanding based on cases of verrucous carcinoma described thus far, and discuss recent advances in understanding of the pathogenesis of verrucous esophageal carcinoma that may aid in molecular diagnostics.
{"title":"Diagnosis and Management of Verrucous Carcinoma of the Esophagus","authors":"Jay Shi, Jon O. Wee, Lei Zhao","doi":"10.1177/26345161241249384","DOIUrl":"https://doi.org/10.1177/26345161241249384","url":null,"abstract":"Verrucous esophageal carcinoma is an extremely rare subtype of squamous cell carcinoma of the esophagus that is characterized by a friable exophytic mass but is often deceptively low-grade and superficially well-differentiated on mucosal biopsies, making pathologic diagnosis challenging. Distant metastasis is rare in these tumors. Therefore, early diagnosis is crucial as surgical resection is frequently curative. Conversely, delay in diagnosis can lead to extensive local invasion and result in severe morbidity and death. In this article, we will outline the history of verrucous esophageal carcinoma, review the current clinical understanding based on cases of verrucous carcinoma described thus far, and discuss recent advances in understanding of the pathogenesis of verrucous esophageal carcinoma that may aid in molecular diagnostics.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"99 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140968241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.1177/26345161241252932
Terry L. Jue, William L. Hasler
Gastroparesis presents with nausea, early satiety, vomiting, bloating, distention, and abdominal pain and is diagnosed by documenting delayed passage of contents from the stomach to the intestines in the absence of mechanical obstruction. Several factors contribute to gastroparesis pathophysiology. Pylorospasm, or increased pyloric contractility, is present in many patients and may be a target for therapy of cases of refractory gastroparesis when medical management is insufficient. Pylorus-directed interventions including botulinum toxin injections, pneumatic balloon dilation, stenting, surgical pyloroplasty, and gastric per-oral endoscopic myotomy are increasingly employed to treat selected patients with gastroparesis who are unresponsive to medications.
{"title":"The Impact of Pyloric Directed Therapy for Gastroparesis","authors":"Terry L. Jue, William L. Hasler","doi":"10.1177/26345161241252932","DOIUrl":"https://doi.org/10.1177/26345161241252932","url":null,"abstract":"Gastroparesis presents with nausea, early satiety, vomiting, bloating, distention, and abdominal pain and is diagnosed by documenting delayed passage of contents from the stomach to the intestines in the absence of mechanical obstruction. Several factors contribute to gastroparesis pathophysiology. Pylorospasm, or increased pyloric contractility, is present in many patients and may be a target for therapy of cases of refractory gastroparesis when medical management is insufficient. Pylorus-directed interventions including botulinum toxin injections, pneumatic balloon dilation, stenting, surgical pyloroplasty, and gastric per-oral endoscopic myotomy are increasingly employed to treat selected patients with gastroparesis who are unresponsive to medications.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"14 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140967721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1177/26345161241249381
Andrés R Latorre-Rodríguez, Seema Munir, Sumeet K Mittal
Management strategies for gastroesophageal reflux disease (GERD) include lifestyle changes, medications, and surgery. A very low carbohydrate diet (VLCD) may offer an effective treatment option. Thus, we aimed to evaluate the effects of a VLCD on GERD through a literature review and exploratory study. We performed a literature search using MeSH and free-text terms in MEDLINE, EMBASE, Cochrane, and Google Scholar to summarize the available evidence through March 2023. Furthermore, we conducted an exploratory study in patients with GERD and a BMI > 25 kg/m2 without prior antireflux surgery. The subjects followed a strict VLCD guided by a medical bariatrician for 4 weeks and completed periodical medical and laboratory evaluations. Descriptive and inferential statistics were applied to assess the covariates before and after intervention. Significance level (α) was set at .05. We found 5 studies reporting the effects of a VLCD on GERD. All of them reported relief of GERD-related symptoms and a decrease in distal acid exposure time (AET) in the short term (6 days to 16 weeks) in most subjects. In our exploratory study, a VLCD reduced the mean BMI (32.2 ± 2.75 vs 30.4 ± 2.23 kg/m2, P = .022) and AET (10.8 ± 3.7 vs 5.5 ± 4.2%, P = .049) among the cohort. Moreover, the DeMeester score and number of proximal reflux episodes improved in 3 patients, and the GERD-Health Related Quality of Life score improved in all 4. Current evidence, including our exploratory study, suggests that a VLCD in overweight or obese patients with GERD may have significant immediate benefits. Further studies are warranted.
{"title":"Effect of Ketogenic Diet on Gastroesophageal Reflux Disease: Literature Review and Exploratory Study","authors":"Andrés R Latorre-Rodríguez, Seema Munir, Sumeet K Mittal","doi":"10.1177/26345161241249381","DOIUrl":"https://doi.org/10.1177/26345161241249381","url":null,"abstract":"Management strategies for gastroesophageal reflux disease (GERD) include lifestyle changes, medications, and surgery. A very low carbohydrate diet (VLCD) may offer an effective treatment option. Thus, we aimed to evaluate the effects of a VLCD on GERD through a literature review and exploratory study. We performed a literature search using MeSH and free-text terms in MEDLINE, EMBASE, Cochrane, and Google Scholar to summarize the available evidence through March 2023. Furthermore, we conducted an exploratory study in patients with GERD and a BMI > 25 kg/m2 without prior antireflux surgery. The subjects followed a strict VLCD guided by a medical bariatrician for 4 weeks and completed periodical medical and laboratory evaluations. Descriptive and inferential statistics were applied to assess the covariates before and after intervention. Significance level (α) was set at .05. We found 5 studies reporting the effects of a VLCD on GERD. All of them reported relief of GERD-related symptoms and a decrease in distal acid exposure time (AET) in the short term (6 days to 16 weeks) in most subjects. In our exploratory study, a VLCD reduced the mean BMI (32.2 ± 2.75 vs 30.4 ± 2.23 kg/m2, P = .022) and AET (10.8 ± 3.7 vs 5.5 ± 4.2%, P = .049) among the cohort. Moreover, the DeMeester score and number of proximal reflux episodes improved in 3 patients, and the GERD-Health Related Quality of Life score improved in all 4. Current evidence, including our exploratory study, suggests that a VLCD in overweight or obese patients with GERD may have significant immediate benefits. Further studies are warranted.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141002272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1177/26345161241249382
Jenson Phung, Mohammad Bilal
Esophageal stent placement is an effective technique used in the management of different benign and malignant conditions. Over time, various types of stents and techniques have been developed and optimized to treat distinct pathologies. With the extensive array of strategies available for utilizing esophageal stenting, a thorough understanding of the characteristics of each stent type and usage is paramount in choosing the ideal stent in a particular case. This article presents a brief review of esophageal stenting as well as tips and tricks for clinical practice.
{"title":"How I Do It: Esophageal Stenting for Benign and Malignant Conditions","authors":"Jenson Phung, Mohammad Bilal","doi":"10.1177/26345161241249382","DOIUrl":"https://doi.org/10.1177/26345161241249382","url":null,"abstract":"Esophageal stent placement is an effective technique used in the management of different benign and malignant conditions. Over time, various types of stents and techniques have been developed and optimized to treat distinct pathologies. With the extensive array of strategies available for utilizing esophageal stenting, a thorough understanding of the characteristics of each stent type and usage is paramount in choosing the ideal stent in a particular case. This article presents a brief review of esophageal stenting as well as tips and tricks for clinical practice.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141009640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1177/26345161241240455
Jordan C. Malone, Robinder P. Abrol, Gabriel L. Reep, Mohamed O. Othman
Esophageal squamous papilloma (ESP) is an uncommon, normally benign epithelial neoplasm with rare potential for malignant transformation. These lesions are oftentimes found incidentally on upper endoscopy and are typically managed with endoscopic excision, dissection, or ablation. However, there remains a paucity of published management guidelines in the current literature. We present a case of an older female who was found to have an extensive mid-esophageal ESP with recurrence despite endoscopic intervention. We highlight the multi-institutional management approach to her morphologically atypical ESP and the nuance involved in treating recurrent lesions of this type.
{"title":"Approach to Management of Recurrent Esophageal Squamous Papilloma","authors":"Jordan C. Malone, Robinder P. Abrol, Gabriel L. Reep, Mohamed O. Othman","doi":"10.1177/26345161241240455","DOIUrl":"https://doi.org/10.1177/26345161241240455","url":null,"abstract":"Esophageal squamous papilloma (ESP) is an uncommon, normally benign epithelial neoplasm with rare potential for malignant transformation. These lesions are oftentimes found incidentally on upper endoscopy and are typically managed with endoscopic excision, dissection, or ablation. However, there remains a paucity of published management guidelines in the current literature. We present a case of an older female who was found to have an extensive mid-esophageal ESP with recurrence despite endoscopic intervention. We highlight the multi-institutional management approach to her morphologically atypical ESP and the nuance involved in treating recurrent lesions of this type.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"29 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140237310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1177/26345161241239607
D. Cangemi, Brian E Lacy
Gastroparesis (GP) is a disorder characterized by symptoms of nausea, vomiting, early satiety, abdominal pain, and/or bloating in the setting of delayed gastric emptying and the absence of a mechanical obstruction. Though the epidemiology and many pathophysiologic mechanisms have been well-established, GP remains an incompletely understood gastrointestinal disorder, and recent data has challenged existing concepts regarding the etiology, diagnosis, and treatment of GP. Thus, our understanding of GP is evolving and with this comes the promise of novel diagnostic methods and treatments, both of which are sorely needed for this historically vexing disorder, which presents unique challenges to patients and providers alike. In this section, we will review existing principles pertaining to the pathophysiology and evaluation of GP, and contrast this with recent data, some of which challenges the historical perspective. In so doing, we aim to provide the reader with an updated and sophisticated view on the approach to GP moving forward.
胃轻瘫（GP）是一种以恶心、呕吐、早饱、腹痛和/或腹胀等症状为特征的疾病，表现为胃排空延迟且无机械性梗阻。虽然 GP 的流行病学和许多病理生理机制已经得到了很好的证实，但人们对它的了解仍然不够全面，而且最近的数据也对 GP 的病因、诊断和治疗方面的现有概念提出了挑战。因此，我们对 GP 的认识正在不断发展，同时也带来了新的诊断方法和治疗方法，而这两种方法都是这种历来令人头疼的疾病所急需的，它给患者和医疗服务提供者都带来了独特的挑战。在本节中，我们将回顾有关 GP 病理生理学和评估的现有原则，并将其与最新数据进行对比，其中一些数据对历史观点提出了挑战。这样做的目的是为读者提供一个最新的、复杂的视角，让读者了解 GP 的未来发展方向。
{"title":"Motility Disorders of the Stomach: Pathophysiologic Mechanisms and Evaluation","authors":"D. Cangemi, Brian E Lacy","doi":"10.1177/26345161241239607","DOIUrl":"https://doi.org/10.1177/26345161241239607","url":null,"abstract":"Gastroparesis (GP) is a disorder characterized by symptoms of nausea, vomiting, early satiety, abdominal pain, and/or bloating in the setting of delayed gastric emptying and the absence of a mechanical obstruction. Though the epidemiology and many pathophysiologic mechanisms have been well-established, GP remains an incompletely understood gastrointestinal disorder, and recent data has challenged existing concepts regarding the etiology, diagnosis, and treatment of GP. Thus, our understanding of GP is evolving and with this comes the promise of novel diagnostic methods and treatments, both of which are sorely needed for this historically vexing disorder, which presents unique challenges to patients and providers alike. In this section, we will review existing principles pertaining to the pathophysiology and evaluation of GP, and contrast this with recent data, some of which challenges the historical perspective. In so doing, we aim to provide the reader with an updated and sophisticated view on the approach to GP moving forward.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"23 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140240246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1177/26345161241238748
Muftah Mahmud, Ananya Munjal, M. Savani, Hninyee Win, U. Rozell, Juniad Arshad
Esophageal squamous cell carcinoma (ESCC) constitutes an aggressive subset of esophageal cancers that portends a poor prognosis. Management of ESCC has been historically challenging due to the limited effective therapeutic options. Broadening our understanding of the molecular landscape and identifying reliable biomarkers are essential in early detection, monitoring disease response and advancing treatment strategies. Recently, immunotherapy and tyrosine kinase inhibitors have changed the treatment algorithm of ESCC. In this review, we explore the molecular landscape and biomarkers that can aid in the management of ESCC and discuss the role of immunotherapy and tyrosine kinase inhibitors in the treatment of ESCC.
{"title":"Biomarker Testing and Role of Tyrosine Kinase Inhibitors and Immunotherapy for Esophageal Squamous Cell Carcinoma","authors":"Muftah Mahmud, Ananya Munjal, M. Savani, Hninyee Win, U. Rozell, Juniad Arshad","doi":"10.1177/26345161241238748","DOIUrl":"https://doi.org/10.1177/26345161241238748","url":null,"abstract":"Esophageal squamous cell carcinoma (ESCC) constitutes an aggressive subset of esophageal cancers that portends a poor prognosis. Management of ESCC has been historically challenging due to the limited effective therapeutic options. Broadening our understanding of the molecular landscape and identifying reliable biomarkers are essential in early detection, monitoring disease response and advancing treatment strategies. Recently, immunotherapy and tyrosine kinase inhibitors have changed the treatment algorithm of ESCC. In this review, we explore the molecular landscape and biomarkers that can aid in the management of ESCC and discuss the role of immunotherapy and tyrosine kinase inhibitors in the treatment of ESCC.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"11 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140254999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1177/26345161241234820
John E. Wang, Andre Jove, Joo Ha Hwang, Robert J. Huang
Gastric intestinal metaplasia (GIM) is a known precursor to gastric adenocarcinoma (GAC). Although the true prevalence of GIM is not known, it is estimated that around 5% of patients in the United States who undergo upper endoscopy with biopsies have GIM. Understanding the risk factors for progression to GAC is integral for management of this condition. In this review article, we discuss risk factors for progression to GAC and the implications for the management of patients with GIM.
{"title":"The Risk of Gastric Intestinal Metaplasia and Implications for Management","authors":"John E. Wang, Andre Jove, Joo Ha Hwang, Robert J. Huang","doi":"10.1177/26345161241234820","DOIUrl":"https://doi.org/10.1177/26345161241234820","url":null,"abstract":"Gastric intestinal metaplasia (GIM) is a known precursor to gastric adenocarcinoma (GAC). Although the true prevalence of GIM is not known, it is estimated that around 5% of patients in the United States who undergo upper endoscopy with biopsies have GIM. Understanding the risk factors for progression to GAC is integral for management of this condition. In this review article, we discuss risk factors for progression to GAC and the implications for the management of patients with GIM.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"63 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140252418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1177/26345161241237523
Maunil N. Bhatt, Praveen Sridhar, Sainath Asokan, Parth Shah, Fenil Gandhi, Pratiksha Shah, Parth Patel, Kei Suzuki, Sanjay Rajput, Vipal H Parmar, Bhavna Mehta, Tony E. Godfrey, Virginia R. Litle
Conventional endoscopy remains the gold standard for detecting esophageal squamous cell carcinoma (ESCC) despite its high cost and need for expertise. In resource-poor regions, a less labor-intensive yet accurate screening tool is needed. The purpose of this study is to assess feasibility of establishing a non-endoscopic screening program in rural India and to test the diagnostic accuracy of the EsophaCap swallowable sponge in detecting ESCC in a high-risk patient population. A prospective cohort study was conducted between 2017 and 2019, in which subjects with risk factors for ESCC (tobacco smoking or chewing, betel nut/leaf, alcohol and hot beverage consumption) were approached during upper endoscopy visits at a clinic in Western India. After obtaining EsophaCap sponge cytology samples, random endoscopic biopsies were obtained at 20 and 30 cm from the incisors. Histologic diagnoses were confirmed and select biopsy samples were sequenced for genomic aberrations. Visual Analog Scale (VAS) scores were used to assess patient experience of sponge swallowing (range 1-5, “very comfortable” to “very uncomfortable”). In our cohort of 178 patients, 157 (88%) were males. Mean age was 52 ± 12 years. Sixty-eight (38%) patients were current cigarette or bidi smokers; 132 (74%) patients were daily tobacco chewers, and 83 (47%) patients chewed betel nuts/leaves on a daily basis. Forty-six (26%) patients were daily alcohol users and 151 (85%) patients drank ≥3 hot beverages per day. The median number of risk factors per patient was 3. The first-time swallow rate of the encapsulated sponge was successful in 190/200 (95%) patients. Median VAS score was 2 (“comfortable”). EsophaCap cytology revealed 6 (3%) patients with atypical squamous cells of unknown significance (ASCUS) and 3 (1%) patients with dysplasia. Based on the endoscopic biopsies, 6 (3%) patients had ESCC, 4 (2%) patients had lesions with squamous dysplasia, and 63 (35%) patients had esophageal leukoplakia. Four patients classified as ASCUS pathology via EsophaCap were normal, benign, or leukoplakia via endoscopy. EsophaCap’s sensitivity and specificity for detecting dysplasia or ESCC by histology was 30% and 97%, respectively. Establishing a non-endoscopic screening program in a high-risk area with language barriers and low medical literacy is very safe and feasible. EsophaCap may help identify ASCUS patients in need of serial endoscopic monitoring. Further studies of combined sponge cytology with immunohistochemistry studies are necessary to improve accuracy of ESCC screening.
{"title":"EsophaCap Sponge Cytology Screening for Esophageal Squamous Cell Dysplasia and Carcinoma is Feasible in a High-Risk Area in Western India","authors":"Maunil N. Bhatt, Praveen Sridhar, Sainath Asokan, Parth Shah, Fenil Gandhi, Pratiksha Shah, Parth Patel, Kei Suzuki, Sanjay Rajput, Vipal H Parmar, Bhavna Mehta, Tony E. Godfrey, Virginia R. Litle","doi":"10.1177/26345161241237523","DOIUrl":"https://doi.org/10.1177/26345161241237523","url":null,"abstract":"Conventional endoscopy remains the gold standard for detecting esophageal squamous cell carcinoma (ESCC) despite its high cost and need for expertise. In resource-poor regions, a less labor-intensive yet accurate screening tool is needed. The purpose of this study is to assess feasibility of establishing a non-endoscopic screening program in rural India and to test the diagnostic accuracy of the EsophaCap swallowable sponge in detecting ESCC in a high-risk patient population. A prospective cohort study was conducted between 2017 and 2019, in which subjects with risk factors for ESCC (tobacco smoking or chewing, betel nut/leaf, alcohol and hot beverage consumption) were approached during upper endoscopy visits at a clinic in Western India. After obtaining EsophaCap sponge cytology samples, random endoscopic biopsies were obtained at 20 and 30 cm from the incisors. Histologic diagnoses were confirmed and select biopsy samples were sequenced for genomic aberrations. Visual Analog Scale (VAS) scores were used to assess patient experience of sponge swallowing (range 1-5, “very comfortable” to “very uncomfortable”). In our cohort of 178 patients, 157 (88%) were males. Mean age was 52 ± 12 years. Sixty-eight (38%) patients were current cigarette or bidi smokers; 132 (74%) patients were daily tobacco chewers, and 83 (47%) patients chewed betel nuts/leaves on a daily basis. Forty-six (26%) patients were daily alcohol users and 151 (85%) patients drank ≥3 hot beverages per day. The median number of risk factors per patient was 3. The first-time swallow rate of the encapsulated sponge was successful in 190/200 (95%) patients. Median VAS score was 2 (“comfortable”). EsophaCap cytology revealed 6 (3%) patients with atypical squamous cells of unknown significance (ASCUS) and 3 (1%) patients with dysplasia. Based on the endoscopic biopsies, 6 (3%) patients had ESCC, 4 (2%) patients had lesions with squamous dysplasia, and 63 (35%) patients had esophageal leukoplakia. Four patients classified as ASCUS pathology via EsophaCap were normal, benign, or leukoplakia via endoscopy. EsophaCap’s sensitivity and specificity for detecting dysplasia or ESCC by histology was 30% and 97%, respectively. Establishing a non-endoscopic screening program in a high-risk area with language barriers and low medical literacy is very safe and feasible. EsophaCap may help identify ASCUS patients in need of serial endoscopic monitoring. Further studies of combined sponge cytology with immunohistochemistry studies are necessary to improve accuracy of ESCC screening.","PeriodicalId":508891,"journal":{"name":"Foregut: The Journal of the American Foregut Society","volume":"43 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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