Diseases of the Esophagus最新文献

Esophageal squamous cell carcinoma (ESCC) often metastasizes to supraclavicular lymph nodes (SCLNs), which are potentially curable distant metastases by SCLN dissection during esophagectomy. Prophylactic SCLN dissection should be based on an accurate preoperative assessment of SCLN metastasis. We evaluated 199 patients who received neoadjuvant chemotherapy, followed by esophagectomy with three-field lymph node dissection for ESCC. For each patient, the largest SCLN was measured on the left and right sides. Long- and short-axis diameters of 398 SCLNs were measured using computed tomography (CT), and long-to-short-axis ratio was calculated. Diagnostic accuracies of the long- and short-axis diameters and long-to-short-axis ratio were determined using area under the curve (AUC) of the receiver operating characteristic plot. Of the 199 patients, 16.6% had pathological SCLN metastasis. AUCs of the short-axis diameter had the most significant values in the left and right sides compared with the other variables, at 0.93 (95% confidence interval [CI]: 0.89-0.97) for the left side and 0.92 (95% CI: 0.87-0.97) for the right side. When the short-axis diameter was <5 mm after chemotherapy, negative predictive value was sufficiently high (99.4% and 98.2% for the left and right SCLNs, respectively). In contrast, when the diameter exceeded 8 mm, positive predictive value increased to 71.4% and 83.3% in the left and right SCLNs, respectively. The short-axis diameter of the largest SCLN on CT after neoadjuvant chemotherapy appears to be a helpful indicator for diagnosing SCLN metastasis in patients with ESCC after neoadjuvant chemotherapy.

Background: Lymphocytic esophagitis (LyE) is a novel rare esophageal disorder characterized by intraepithelial lymphocytic infiltration of the esophagus in a peripapillary distribution, without the involvement of granulocytes. The optimal treatment strategy for this condition remains uncertain. We aimed to synthesize the current evidence for the treatment of lymphocytic esophagitis.

Methods: We performed a systematic review according to PRISMA guidelines, searching MEDLINE, Embase, and Google Scholar. Studies with non-primary data or insufficient treatment data were excluded. Descriptive statistics were performed on patient demographics and treatment outcomes.

Results: Thirty nine articles from 2012-2024 were included (154 patients total). Proton pump inhibitors (PPIs) were the most common initial therapy for LyE (n = 65), followed by topical steroids (n = 23). A greater proportion of patients experienced a symptomatic, endoscopic, and histologic response from the initial use of topical steroids as monotherapy or part of combination therapy (with PPIs) compared to PPIs alone. Symptomatic recurrence was more common after initial use of topical steroids compared to PPIs. Balloon dilation was effective in relieving symptomatic esophageal dysphagia. Other therapies included biologics, endoscopic botulinum injections, sucralfate, and tacrolimus. The average follow-up duration was 8.98 months.

Conclusions: For patients with LyE, topical steroids seem to provide greater symptomatic and histologic benefit compared to PPIs, although recurrence is more common. For patients not already on acid suppression therapy, PPIs may still be a reasonable first-line option, especially when prioritizing safety. Further prospective studies are needed to formally assess the comparative safety and efficacy of the various treatment modalities, including novel immunosuppressive therapies.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus. Dupilumab, an IL-4/IL-13 inhibitor, was approved for EoE in 2022, but real-world data remain limited. We evaluated its effectiveness in a single tertiary care center uninvolved in prior clinical trials. We conducted a retrospective cohort study of adults (≥18 years) with confirmed EoE (≥15 eos/hpf) who initiated dupilumab therapy between 1/2022 and 10/2024 and evaluated symptom burden, endoscopic severity, histologic activity, as well as adverse events. Ultimately, 44 patients were included with significant decreases in clinical symptom and endoscopic scoring. Peak eosinophil counts declined by a median of 47.5 eos/hpf. Histologic remission occurred in 76.9% at follow-up 1 and maintained in 72.7% at follow-up 2. About 15.9% of patients reported AEs and 9.1% discontinued therapy. These findings are consistent with the clinical trial and recent observational data, supporting dupilumab's effectiveness and generalizability in real-world practice.

Hospital-acquired pneumonia (HAP) is a common and challenging complication following esophagectomy, with definitions that vary widely across clinical and research settings. The Centres for Disease Control and Prevention (CDC) criteria are endorsed by international consensus groups as a reference standard, but their relevance in postoperative surgical populations remains uncertain. This study aimed to assess the diagnostic performance of alternative criteria, including the American Thoracic Society (ATS) guidelines, the Utrecht definition, and the Clinical Pulmonary Infection Score (CPIS), as well as clinical diagnoses made at our center, compared against the CDC definition. We conducted a retrospective review of all consecutive esophagectomies performed at a regional specialist center from 2014-2022. Data included patient demographics, comorbidities, imaging, and postoperative outcomes. The CDC criteria were used as the reference standard for HAP, against which the sensitivity and specificity of the ATS, Utrecht, and CPIS criteria, as well as clinical diagnoses, were evaluated. Among 460 patients, 223 (48.5%) were treated for HAP, but only 56 (12.2%) met CDC criteria. The ATS criteria demonstrated the highest agreement with the CDC definition (sensitivity 97.5%, specificity 92.0%), while the Utrecht and CPIS criteria showed lower specificity. Clinical diagnoses demonstrated high sensitivity (88.9%) but low specificity (50.1%) relative to CDC-defined HAP. The mean time to HAP diagnosis was 5 days (SD ± 3.7), and just over half of treated patients had positive sputum cultures. There is significant variability in HAP diagnosis following esophagectomy depending on which criteria are applied. Clinical diagnoses often exceed formal definitions, suggesting a risk of overdiagnosis and overtreatment. These findings support the need for tailored, consensus-based criteria to improve diagnostic accuracy, guide appropriate treatment, and enhance benchmarking across centers.

Central obesity is a risk factor for esophageal adenocarcinoma (EAC) independent of acid reflux. However, about a quarter of patients with Barrett's esophagus (BE) and EAC have a normal body mass index (BMI). One hypothesis is that chronic systemic inflammation is as critical to the cancer pathway than the BMI alone. Therefore, we hypothesized that lean patients with BE/EAC would have a high prevalence of metabolic diseases. We aimed to compare metabolic diseases among lean patients with BE/EAC and overweight/obese BE/EAC and lean control without BE/EAC. We performed a propensity score-matched case-control study including patients with BE/EAC and a control group without BE/EAC from the Rochester Epidemiology Project (REP). The groups were compared using chi-square χ 2 and Student t-test as appropriate. Adjusted logistic regression models were used to compare the association with metabolic diseases. We included a total of 2504 patients (631 EAC, 621 BE, and 1252 controls). A quarter of patients (24.6%) with BE/EAC were lean. When compared to controls without BE/EAC, lean patients with BE were more likely to have diabetes (32.2% vs. 11.2%, P < 0.001) and hyperlipidemia (76.2% vs. 53%, P < 0.001). When comparing lean EAC patients to controls without BE/EAC, lean patients had a higher association with smoking (73.3% vs. 58.6%, P: 0.002) and diabetes (18.7% vs. 11.2%, P: 0.03). When compared to overweight/obese BE patients, lean BE were less likely to have NASH (7.7% vs. 20.3%, P: 0.001), diabetes (32.3% vs. 42.1%, P: 0.03), hyperlipidemia (77.2% vs. 87%, P: 0.003), and metabolic syndrome (24% vs. 54%, P < 0.001). Similarly, when compared to overweight/obese patients with EAC, lean EAC patients were less likely to have NASH (0% vs. 15.5%, P < 0.001), diabetes (18.7% vs. 34.1%, P < 0.001), hyperlipidemia (37.3% vs. 51.8%, P: 0.002), hypertension (37.3% vs. 55.3%, P < 0.001), and metabolic syndrome (8% vs. 37.6%, P < 0.001). A quarter of patients with BE/EAC are lean. Although lean BE/EAC patients have a more favorable metabolic profile compared to overweight/obese BE/EAC patients, diabetes and smoking are more common among lean patients with EAC compared to lean controls. The higher association with smoking and diabetes among lean EAC challenges traditional risk factor paradigms, suggesting a significant role for insulin resistance and chronic inflammation in EAC pathogenesis, especially in patients without typical risk factors. BMI-determined obesity may need to be supplemented with inflammatory metabolic diseases to improve assessment of BE/EAC risk in lean patients.

Background: Immunotherapy improves survival with manageable toxicity in esophageal cancer as neoadjuvant, first-line, or second-line therapy. However, its adjuvant role in esophageal squamous cell carcinoma (ESCC) remains uncertain. This study evaluates whether adjuvant immunotherapy enhances survival in ESCC.

Methods: We conducted a multicentric propensity-score matching analysis in patients with unresected ESCC who underwent radiotherapy between January 2015 and December 2024. Kaplan-Meier analysis was employed to generate survival curves, with comparisons made via the log-rank test. Univariate and multivariate-analyses employed Cox regression models.

Results: A total of 207 patients were enrolled. Among them, 60 patients received immunotherapy, while 147 did not receive adjuvant immunotherapy. The median overall survival (OS) was 42 months in the immunotherapy group, compared with 22.0 months in the non-immunotherapy group (HR, 0.55; 96.4%CI, 0.32 to 0.93). The median progression-free survival (PFS) was 26 months in the adjuvant immunotherapy group versus 17 months in the non-adjuvant group, showing a statistically significant difference (HR, 0.58; 95%CI, 0.36 to 0.95). After propensity score matching, the results remained consistent with the overall cohort. Compared with the non-adjuvant group, adjuvant immunotherapy significantly improved both PFS (HR, 0.49; 95%CI, 0.27 to 0.89) and OS (HR, 0.50; 95%CI, 0.29 to 0.85). Eastern Cooperative Oncology Group performance-status score, tumor stage, and maximum tumor thickness are independent prognostic factors in univariate-analyses. In multivariate-analyses, no significant prognostic factors were identified.

Conclusions: Patients with unresected ESCC who received adjuvant immunotherapy following radiotherapy demonstrated significantly longer OS and PFS compared to those who did not receive adjuvant immunotherapy.

Patients after esophagectomy often face challenges in oral intake rehabilitation and nutritional management, which may affect rehabilitation outcomes. Semi-structured interviews were conducted with 15 patients during the oral intake rehabilitation period following esophagectomy, who attended follow-up visits between April and May 2025. The participants were 1 to 10 months post-surgery at the time of interview. All interviews were conducted face-to-face by a trained nursing postgraduate student experienced in qualitative research. The collected data were analyzed using Colaizzi's seven-step method. Four themes and eleven subthemes were identified: (i) Challenges in adapting to oral intake (forced changes in eating habits, prominent gastrointestinal discomfort, and negative emotions related to eating), (ii) coping strategies for oral intake difficulties (different perspectives on dietary practices during recovery, varied information-seeking channels, and differences in awareness of nutritional monitoring), (iii) existing barriers during the oral intake rehabilitation period (difficulties in food selection, ambiguous understanding of the timing of dietary transition, and challenges in calculating nutritional intake), and (iv) needs during the oral intake rehabilitation period (desire for more nutrition-related health education and demand for more accessible consultation platforms). Patients during the oral intake rehabilitation following esophagectomy face multiple barriers and needs. Healthcare professionals should place greater emphasis on patients' changes in eating habits, symptom burden, and psychological stress during the dietary transition, optimize pre-discharge education, develop dynamic nutritional intervention strategies, promote multidisciplinary collaboration, and establish digital information support platforms to meet patients' long-term nutritional needs.

Symptoms of dysphagia and chest pain in large paraoesophageal hernias (POH) can mimic disorders of esophageal motility. High-resolution manometry (HRM) is the gold standard for assessing esophageal motility, however limited data exist in the settings of giant POH. Technical failure of HRM has been historically frequent due to the difficulty of negotiating the cardio-esophageal junction. Prospectively populated database containing records of patients undergoing POH repair was analyzed for the period between 2019 and 2024. Inclusion criteria were the presence of a large POH, pre-operative HRM, and post-operative HRM. Primary outcomes were HRM success rate and manometric changes before and after surgery. Secondary outcomes were patient-reported heartburn, regurgitation, and dysphagia. Multivariate analysis assessed correlations between symptoms and manometric findings. Preoperative HRM was attempted in 71 and succeeded in 64 (90.1%) patients of whom 41 completed post-operative HRM. Mean age was 72.5 years, 85% female. Esophagogastric junction contractile integral (EGJ-CI) increased from 33.3 to 41.9 mmHg/cm (P = 0.018), with no significant changes in integrated relaxation pressure, distal contractile integral, or proximal contractile integral; EGJ morphology normalized in most patients. Ineffective esophageal motility was present in 22% preoperatively and 19.5% post-operatively. Symptoms improved significantly: heartburn (P < 0.01), regurgitation (P = 0.03), and dysphagia (P = 0.01). HRM was feasible in most patients with large POH. Surgical repair led to significant symptom improvement and normalization of EGJ morphology, despite minimal changes in peristaltic measures. These findings suggest that symptom improvement may occur independently of measurable motility criteria.