Diseases of the Esophagus最新文献

Despite advances in neonatal surgery and intensive care, esophageal atresia (EA) continues to carry a substantial risk of early postoperative mortality. The aim of this study was to investigate risk factors for 30-day mortality in neonates undergoing surgery for EA. Following approval by our institutional ethics committee, we conducted a retrospective study from January 1, 2010 to December 31, 2024, in a pediatric surgery department. All neonates (≤28 days) who underwent primary surgery for EA were included. During the 15-year study period, 113 neonates underwent surgery for EA, with 52.2% being male. Twenty-nine (25.7%) patients died within the first 30 postoperative days. The univariable analysis comparing non-survivors and survivors groups revealed that cardiac comorbidities, gestational age < 37 weeks, 5-min Apgar score ≤ 8, birth weight < 2500 g, and postoperative intubation time > 60 hours were potential risk factors for mortality. On multivariable logistic regression analysis, three factors emerged as independent predictive factors of 30-day mortality. These factors included birth weight < 2500 g (OR = 66.408; 95% CI: 5.887-749.164; P = 0.001), Apgar score (5 min) ≤ 8 (OR = 15.213; 95% CI: 3.444-67.197; P < 0.001), and cardiac comorbidities (OR = 9.768; 95% CI: 1.626-58.665; P = 0.013). Our findings may serve as a valuable tool for the early identification of neonates at increased risk of postoperative mortality, enabling timely risk stratification, optimized perioperative management, and improved decision-making in neonatal surgical care.

Current diagnostic criteria for anastomotic leakage (AL) after esophagectomy are insufficient for early diagnosis and treatment because of their oversimplified binary approach to the complication. A diagnostic spectrum is proposed, introducing the category of possible leak (PoL), leading to increased consideration of AL exclusion, and justifying PoL treatment options.

Esophageal cancer represents a substantial global health challenge, marked by poor prognosis, even after curative treatment. Health-related quality of life is crucial for evaluating the treatment efficacy and long-term outcomes in patients with esophageal cancer. This state-of-the-art review and evidence gap map sought to identify existing research on the impact of interventions on health-related quality of life in adults with esophageal cancer, providing a comprehensive overview of various health-related quality of life aspects following diagnosis and treatment. This review entailed a systematic literature search, data extraction, and analysis, with the findings visualized in an evidence and gap map. The review synthesized key insights from the literature, focusing on clinical context, treatment, health-related quality of life outcomes, and interventions to enhance health-related quality of life. The evidence and gap map revealed that most studies concentrated on surgical interventions, chemotherapy/chemoradiotherapy, supportive care, and lifestyle interventions, primarily evaluating the overall quality of life, symptom burden, and emotional and psychological health. Several areas remain unexplored, including cognitive and existential well-being, social functioning, and the impact of specific interventions such as immunotherapy. This review underscores the need for high-quality longitudinal studies assessing long-term health-related quality of life, the inclusion of health-related quality of life as a primary or key secondary endpoint in future trials, and improved methodological quality of systematic reviews. Addressing these gaps will contribute to a more patient-centered, evidence-based approach to esophageal cancer care.

Post-esophagectomy chyle leak following injury to the thoracic duct and/or its tributaries is a rare but well-recognized complication with a reported incidence of 0.4-21% and a mortality of 0-50%. The aim of this study was to describe our experience as a tertiary esophagogastric cancer center in managing this complication over a 10-year period. This was a retrospective study, using an electronic database, to analyze our incidence and management of chyle leak in all patients who underwent elective esophagectomy between April 2009 and December 2019 in a tertiary upper gastrointestinal cancer center. Non-normally distributed data were presented as a median and range/interquartile range with analysis being conducted using the Mann-Whitney U test. A P-value <0.05 was considered statistically significant. Between 2009 and 2019, a total of 550 patients underwent esophagectomy. Chyle leak was identified in 24 patients (4.4%); all 24 patients had neoadjuvant chemotherapy and underwent an open 2 stage Ivor Lewis esophagectomy with routine ligation of the thoracic duct at the time of operation. 83.3% (n = 20) of chyle leak patients were managed surgically with a median length of stay of 20 days (Range 11 to 148) and mortality of 5% (n = 1). 16.7% (n = 4) were managed conservatively with a median length of stay of 31 days (Range 14 to 51) and mortality of 0%. Our data are consistent with the evidence in the literature, which suggests that early surgical intervention in high volume leaks is safe and effective and low mortality rates with chyle leak can be achieved with surgical intervention. This is crucial in reducing the length of stay in hospital and morbidity. Conservative management is suitable in low volume chyle leak and cases clinically responding to medical management.

Vonoprazan, a potassium competitive acid blocker (P-CAB), shows promise for gastroesophageal reflux disease (GERD). On-demand therapy may reduce costs and drug exposure. This study aimed to compare the efficacy of on-demand versus continuous vonoprazan treatment in the initial management of mild GERD. This observational cohort study enrolled patients with non-erosive reflux disease (NERD) and mild reflux esophagitis (LA grade A/B). Patients were allocated to either on-demand or continuous vonoprazan (20 mg/day) treatment for 4 weeks. Primary outcomes were changes in Gastroesophageal Reflux Disease Questionnaire (GerdQ) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) scores. Secondary outcomes included treatment satisfaction, complete mucosal healing rate, and 24-week relapse rate. The GerdQ score and GERD-HRQL score of the on-demand treatment group decreased significantly after initial treatment compared with the previous one, with statistical significance (P < 0.001). Moreover, there were no significant differences in GerdQ and GERD-HRQL scores between the two groups after the treatment (P = 0.363, P = 0.037; the significance level was P < 0.025). Satisfaction (75.9% vs. 74.3%), complete mucosal healing rates (61.8% vs. 38.8%), and relapse rates (10.2% vs. 8.9%) were comparable in the on-demand and continuous treatment groups. Age (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) and alcohol consumption (OR = 4.31, 95% CI: 1.06-17.41, P = 0.04) were influential factors for symptom burden improvement, and treatment allocation (P = 0.069) had no significant effect on symptom burden improvement. Age (OR = 0.94, 95% CI: 0.91-0.96, P < 0.001) and pre-treatment Los Angeles grade B (OR = 3.28, 95% CI: 1.46-7.34, P = 0.004) were predictors of improved quality of life. This study found on-demand vonoprazan demonstrates comparable efficacy to continuous therapy for mild GERD, offering a cost-effective strategy with minimized drug accumulation risks.

Background: Eosinophilic esophagitis (EoE) frequently presents with dysphagia or food impaction (FI), although gastroesophageal reflux-like (GER-like) symptoms may also occur. Whether EoE patients diagnosed after an FI event may present esophageal symptoms before diagnosis that could raise clinical suspicion remains unclear. This study aimed to assess differences in symptoms occurrence before EoE diagnosis, endoscopic, and histological activity, and diagnostic delay, between patients diagnosed after an FI event and those diagnosed with no FI (NFI patients).

Methods: A retrospective study was conducted, including consecutive adult EoE patients (May 2023-February 2025). EoE was defined by a peak eosinophil count (PEC) ≥ 15 eos/high-powered field. All patients were evaluated within 2 weeks of diagnosis, and symptoms occurrence before EoE diagnosis was assessed using a structured questionnaire. FI and NFI patients were compared in terms of symptoms occurrence, clinical, endoscopic, and histological features, and diagnostic delay.

Results: 57 EoE patients (73.7% male; mean age 38.4 ± 15.0 years) were included. Among them, 19 (33.3%) were diagnosed after an FI event, and 38 (66.7%) in the absence of an FI event. No differences were observed in terms of gender, age, and allergic comorbidities. Prior proton pump inhibitor use was more frequently observed in NFI patients (65.8% vs. 36.8%, P = 0.0502). FI patients had a significantly longer diagnostic delay (14.4 ± 12.1 vs. 6.4 ± 7.3 years, P = 0.0030), and they more frequently reported the absence of esophageal symptoms before EoE diagnosis (47.4% vs. 2.6%, P = 0.0001). Before EoE diagnosis, dysphagia, heartburn, and reflux-like symptoms were significantly less frequent in FI patients (47.4% vs. 89.5%, P = 0.001; 15.8% vs. 63.2%, P = 0.0008; and 26.3% vs. 63.2%, P = 0.0119, respectively). The mean EoE Endoscopic Reference Score was higher in FI patients (5.5 ± 1.4 vs. 3.6 ± 2.1, P = 0.0008). EoE patients diagnosed after an FI event seem to be paucisymptomatic before EoE diagnosis, despite showing higher endoscopic activity, suggesting the need for greater awareness among clinicians of symptoms that may raise suspicion of EoE.

Introduction: Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic procedure used for the management of gastroesophageal reflux disease (GERD) in patients with a hiatal hernia <>2 cm. Because TIF involves transmural fasteners placed across the gastroesophageal junction, there is a theoretical risk of vagal nerve injury leading to gastroparesis. Whether this risk differs from that seen with traditional anti-reflux surgery (ARS) remains unclear. Using the TriNetX multi-institutional database, we conducted a retrospective cohort study of adult patients with GERD who underwent either TIF or ARS. Patients with a prior history of gastroparesis or prior use of prokinetic agents were excluded. The primary outcome was the incidence of new-onset gastroparesis within 1 month to 1 year after the procedure; secondary outcome was the use of prokinetic agents. Propensity score matching was applied to balance baseline characteristics, including age, sex, race, BMI, diabetes, PPI, and opioid use. A total of 668 TIF and 53,996 ARS patients were identified. Before matching, gastroparesis incidence was similar between TIF (1.48%) and ARS (1.46%) (adjusted odds ratio [aOR] 1.01, 95% CI 0.54-1.9). After matching, the incidence remained comparable between TIF (0.7%) and ARS (1%) (aOR 1.0, 95% CI 0.22-2.26). The 1-year incidence of prokinetic agent use was lower in the TIF group (3.2%) than in the ARS group (6%) (aOR 0.51, 95% CI 0.3-0.9). In summary, post-surgical gastroparesis is rare after both TIF and ARS, with no significant difference between the two procedures. However, the need for prokinetic therapy was lower following TIF, suggesting a potentially lower burden of postoperative gastric motility symptoms. These findings may help guide counseling and individualized decision-making in GERD management.