Diseases of the Esophagus最新文献

Background: Oropharyngeal dysphagia and aspiration in the early post-esophagectomy period is rarely studied. This study investigated its prevalence, nature and severity, differences across surgical subgroups, and predictors of risk.

Methods: A prospective cohort study was conducted (January 2022-January 2024) at the National Esophageal Cancer Centre. Data was collected on post-operative day (POD) 4 or 5. Swallowing evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2(DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS)]. Functional Oral Intake Scale (FOIS) was used to identify oral intake status.

Results: N = 30 (25 males) were recruited, mean age (range) of 65 (46-80y), n = 13 2-stage, n = 8 3-stage, and n = 9 transhiatal resections. At POD 4/5, 60% (18/30) showed signs of aspiration, with no differences across surgical groups (P = 0.114). Dysphagia per the DIGESTv2 was present in 83% (25/30) of patients, with severe dysphagia in 23% (7/30). MBSImP assessment revealed reduced tongue base retraction (82%), pharyngeal residue (100%) and impaired neo-esophageal clearance (100%). Predictors of aspiration were: pre-operative abnormal FOIS (score < 7) (OR = 7.00, 95%CI 1.2-38.4; P = 0.024), and > 65 years (OR = 7.80, 95%CI 1.47-41.6; P = 0.016). Predictors for oropharyngeal dysphagia were: abnormal pre-operative FOIS (score < 7) (OR = 7.42, 95%CI 1.22-45.45; P = 0.029); age > 65 years (OR = 11.00, 95%CI 1.99-58.8; P = 0.006) and neoadjuvant treatment (OR = 7.20, 95%CI 1.08-47.96, P = 0.041).

Conclusion: Oropharyngeal dysphagia and aspiration are prevalent in the early period after esophageal cancer surgery. These data should inform an increased input from speech and language specialists in the assessment and management of post-operative patients, and overall caution in the implementation and progression of early per orum intake.

Telehealth remains understudied in patients with eosinophilic esophagitis and eosinophilic gastrointestinal diseases (EGIDs), yet may serve as an important tool for increasing access to providers with EGID-specific expertise. The online patient-centered research network, EGID Partners, provided insight into EGID-related telehealth utilization. Respondents reported that telehealth visits offered the ability to spend adequate time with their healthcare provider and communicate just as effectively as an in-person visit, while also incurring lower travel-related costs and less missed work or school. Here, we provide lessons learned that telehealth can be an effective, acceptable, and feasible method of delivering care to EGID patients.

For potentially curable esophageal cancer (EC) and gastric cancer (GC) patients, the probability of treatment with curative intent varies between hospitals and is associated with survival. This study examines the effect of this variation on health economics outcomes and cost-effectiveness. We performed a cost-effectiveness analysis from a societal perspective in potentially curable EC or GC patients selected from the Netherlands Cancer Registry. Resource use and costs were estimated for each treatment strategy from diagnosis until five years follow-up using a top-down costing method. Hospitals were divided into tertiles of low, medium, or high probability of treatment with curative intent using multilevel multivariable logistic regression. The primary outcome was the incremental cost-effectiveness ratio (ICER). Mean total costs per patient was not significantly different between low, medium, and high probability hospitals for EC (n = 9468) (€47,532 vs. €47,384 vs. €47,825), while for GC (n = 3085) costs were significantly lower in low compared to medium and high probability hospitals (€27,759 vs. €30,183 vs. €29,589, both P < 0.001). Costs per quality adjusted life year (QALY) were slightly lower in high probability hospitals for both EC and GC (EC: €29,181 vs. €28,646 vs. €27,659, GC: €25,003 vs. €22,505 vs. €20,495). ICERs were highest for high vs. medium probability hospitals for EC (€4900/QALY) and for medium vs. low probability hospitals for GC (€10,539/QALY). Variation in treatment with curative intent between hospitals affects health economics outcomes to a limited extent. Although all hospital comparisons were cost-effective, for the highest QALY gain, it is recommended to treat potentially curable patients as in high probability hospitals.

Endoscopic ultrasound (EUS) combined with fine needle aspiration (FNA) can be of additional value to fluorine-18 labeled fluorodeoxyglucose positron emission tomography computed tomography (18FDG-PET-CT) for lymph node staging in esophageal cancer patients. The study objective was to evaluate the impact of routine EUS-FNA after 18FDG-PET-CT staging on radiotherapy planning. Patients with biopsy-proven esophageal carcinoma staged ≥cT2 and eligible for treatment with curative intent, including neoadjuvant chemoradiotherapy (nCRT) or definitive chemoradiotherapy (dCRT), were included. After March 2018, patients who were scheduled for dCRT or ASA 3 were excluded from routine EUS-FNA. The primary outcome was the impact of EUS-FNA after 18FDG-PET-CT on radiotherapy target volume delineation. Subsequently, radiotherapy field modifications were compared with surgical pathology when available. Between 2018 and 2023, 179 patients were included. In 61 patients (34%), the EUS scope was unable to pass through the tumor, limiting lymph node assessment. EUS-FNA altered radiotherapy treatment plans in 24 patients (13%), resulting in a number needed to treat of 7.5. Modifications included expansion of the radiation field in 17 cases, reduction in 6 cases, and both in 1 case. Among surgically resected patients, 10 lymph node stations were added to the radiation field based on EUS-FUNA results. Of these, 7 stations (70%) showed no positive or responsive lymph nodes in the resection specimen, while 3 stations (30%) had 2 positive nodes, and 1 with a complete response to nCRT. Four lymph node stations were with no positive nodes found in the resection specimen. Two patients were readmitted post-procedure, including one fatal case of mediastinitis potentially linked to EUS-FNA. Routine EUS-FNA after18FDG-PET-CT altered radiotherapy plans in only 13% of patients, with limited and uncertain impact on clinical outcomes, especially for those undergoing planned neoadjuvant therapy and surgery. These findings suggest that EUS-FNA may be best avoided in routine practice for such patients.

Dupilumab, the first biologic approved for eosinophilic esophagitis treatment (EoE-tx) in 2022, demonstrated favorable safety in phase-III clinical trials. However, real-world dupilumab-associated adverse reactions (DARs) for EoE-tx are unknown. This study aims to evaluate DAR for EoE-tx using the FDA Adverse Event Reporting System. FDA Adverse Event Reporting System was queried for DAR between 2022Q1 and 2023Q4. Individual DARs (iDARs) were categorized and compared between treatment groups: EoE, asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyps. Logistic regression was used to predict serious DAR and outcomes, and zero-truncated negative binomial regression was used to predict the number of iDAR. There were 51,000 DAR observations; 1459 for EoE-tx with 103 (7.1%) serious reactions and 44 (3.0%) serious outcomes including 3 deaths. For EoE-tx, the mean iDAR was 3.68 [3.51, 3.85], and the iDAR incidence rate ratio among men receiving EoE-tx was 0.73 [0.65, 0.83]. EoE-tx average iDAR primarily included general (0.75 [0.70, 0.80]), injection-site (0.69 [0.63, 0.74]), dermatologic (0.51 [0.46, 0.55]), and gastrointestinal (0.24 [0.21, 0.27]) reactions. Adults ≥50 years had 1.97 [1.28, 2.99] higher odds for serious DAR compared to younger adults in EoE-tx. Overall, dupilumab demonstrated a favorable safety profile across all indications, with low rates of serious adverse events. For EoE-tx specifically, higher total iDAR rates were observed, driven largely by increased injection-site and gastrointestinal reactions compared to other indications. Additionally, women exhibited higher iDAR rates than men across all indications.

Chat Generative Pre-trained Transformer (ChatGPT) has emerged as a new technology for physicians and patients to obtain medical information. Our aim was to assess the ability of ChatGPT 4.0 to deliver high-quality information in response to commonly asked questions and management recommendations for Barrett's esophagus (BE). Twenty-nine questions (14 clinical vignettes and 15 frequently asked questions (FAQ)) on BE were entered into ChatGPT 4.0. Using a 5-point Likert scale, three gastroenterologists with expertise in BE rated the 29 ChatGPT responses for accuracy, completeness, empathy, use of excessive medical jargon, and appropriateness to send to patients. Three separate gastroenterologists generated responses to the same 15 FAQs on BE. A group of blinded patients with BE evaluated both ChatGPT and gastroenterologist responses on quality, clarity, empathy and which of the two responses was preferred. Gastroenterologists rated ChatGPT responses as mostly accurate overall (4.01 out of 5) with 79.3% of responses completely accurate or mostly accurate with minor errors. When compared to gastroenterologist responses, the patient panel rated ChatGPT responses to be of significantly higher quality (4.42 vs. 3.07 out of 5) and empathy (4.33 vs. 2.55 out of 5) (p < 0.0001). In conclusion, ChatGPT 4.0 provides generally accurate and comprehensive information about BE. Patients expressed a clear preference for ChatGPT responses over those of gastroenterologists, finding responses from ChatGPT to be of higher quality and empathy. This study highlights the potential use of ChatGPT 4.0 as an adjunctive tool for physicians to provide real-time, high-quality information about BE to their patients.

Eosinophilic esophagitis (EoE) has emerged as a widely recognized disease process, and medical and diet therapies can provide effective anti-inflammatory treatment. However, the progressive fibrostenotic nature of EoE leads to esophageal remodeling and strictures, as well as clinical symptoms of dysphagia and food impaction. In this context, esophageal dilation during endoscopy provides effective symptomatic relief and is an important adjunct therapy. Recognition of esophageal strictures and safe dilation practices is paramount for providers who care for patients with EoE. This review will describe our approach for safe and effective endoscopy management of esophageal strictures in EoE.

Esophageal cancer is a leading cause of cancer-related mortality globally, characterized by poor prognosis and high recurrence rates. This study aimed to systematically evaluate the causes of death and treatment-related toxicities in esophageal cancer patients undergoing concurrent chemoradiotherapy (CCRT), to identify key prognostic factors. Clinical data from 79 patients were analyzed retrospectively, assessing survival outcomes, toxic side effects, and primary causes of death. Results revealed that local control failure and recurrence were the predominant causes of mortality, followed by distant metastasis and lymph node involvement. The overall survival rates at 1, 2, 3, and 4 years were 82.3%, 50.9%, 42.3%, and 40.0%, respectively, with a median survival time of 13 months. Radiation esophagitis and nausea/vomiting were the most common toxicities, though the majority of cases were mild. Tumor length and clinical stage were identified as significant independent prognostic factors, with shorter tumors and early-stage disease correlating with better survival. These findings emphasize the importance of early diagnosis, precise local control, and effective toxicity management in improving patient outcomes. This study provides critical insights into optimizing CCRT strategies, offering practical guidance for enhancing survival and quality of life in esophageal cancer patients.

Sarcopenia, a condition characterized by decreased muscle mass and strength, has been reported to worsen the prognosis of patients with malignancies potentially. However, its impact on short- and long-term outcomes after esophagectomy for esophageal cancer remains unclear. This study aimed to investigate the influence of preoperative sarcopenia on postoperative complications and survival outcomes after esophagectomy. This retrospective study included 187 patients with esophageal cancer who underwent curative esophagectomy at our hospital between 2014 and 2023. Patients were classified into sarcopenia and non-sarcopenia groups based on their preoperative skeletal muscle index (SMI) measured using bioelectrical impedance analysis (BIA). The relationships between sarcopenia and short- and long-term outcomes were analyzed. Sarcopenia was identified in 43.9% (n = 82) of the patients. The sarcopenia group had a significantly higher incidence of postoperative pneumonia than the non-sarcopenia group (31.7% vs. 13.3%, P = 0.004). Survival analysis revealed that the sarcopenia group exhibited poorer overall survival (OS) and non-cancer-specific survival (NCSS) than the non-sarcopenia group. Multivariate analysis demonstrated that sarcopenia was an independent risk factor for postoperative pneumonia in the short term (odds ratio: 2.805, P = 0.007), as well as for poor OS (hazard ratio: 1.994, P = 0.032) and NCSS (hazard ratio: 4.058, P = 0.023) in the long term. Preoperative sarcopenia was an independent predictor of postoperative pneumonia following curative esophagectomy. Sarcopenia has been identified as a risk factor for reduced OS and NCSS. SMI measurement using BIA may be useful for preoperative risk assessment and informing treatment strategies.