Pub Date : 2021-01-01DOI: 10.21037/AOE-2020-EBMG-04
Abdullah Althuwaybi, A. Alamer, M. McDonnell, M. Brennan, R. Rutherford, M. Wilcox, P. Chater, J. Pearson, C. Ward
: When initiated the human microbiome project did not include the lungs and airways in its sampling sites, indicating an under appreciation of the role of the human lung microbiome in health and disease. This paradigm has recently changed through the use of culture independent methods to characterise the human lung microbiome. The original thinking, that the normal lung was essentially sterile, had previously been challenged by findings of microaspiration in normal volunteers and in patients with decreased levels of consciousness. The sterile lung was also questioned by findings of clinically occult infection markers in lung allograft recipients. What is arguably a “rediscovery” of the importance of the human lung microbiome may still underappreciate physiological and patho-physiological inter-relationships between organ systems, studied in separate research disciplines. In particular, microaspiration may be an important, direct mechanism through which the lung microbiome is modulated. As well as aspiration related to gastro-oesophageal reflux and microaspiration the authors feel that the importance of dysphagia in chronic lung disease, will be increasingly recognised in frailty related microbiome exchange between the oropharynx into the lung. This review therefore discusses interconnections in the human microbiome, with a focus on the potential for aerodigestive pathophysiology and microaspiration. Potential connections with human lung disease are discussed and contextualised within a developing literature. This review therefore highlights much needed new targets for translational intervention in lung pathophysiology and underlies the importance of a mixed disciplinary team approach for the future.
{"title":"A narrative review of the potential role of microaspiration and a dysregulated aerodigestive microbiome in lung disease","authors":"Abdullah Althuwaybi, A. Alamer, M. McDonnell, M. Brennan, R. Rutherford, M. Wilcox, P. Chater, J. Pearson, C. Ward","doi":"10.21037/AOE-2020-EBMG-04","DOIUrl":"https://doi.org/10.21037/AOE-2020-EBMG-04","url":null,"abstract":": When initiated the human microbiome project did not include the lungs and airways in its sampling sites, indicating an under appreciation of the role of the human lung microbiome in health and disease. This paradigm has recently changed through the use of culture independent methods to characterise the human lung microbiome. The original thinking, that the normal lung was essentially sterile, had previously been challenged by findings of microaspiration in normal volunteers and in patients with decreased levels of consciousness. The sterile lung was also questioned by findings of clinically occult infection markers in lung allograft recipients. What is arguably a “rediscovery” of the importance of the human lung microbiome may still underappreciate physiological and patho-physiological inter-relationships between organ systems, studied in separate research disciplines. In particular, microaspiration may be an important, direct mechanism through which the lung microbiome is modulated. As well as aspiration related to gastro-oesophageal reflux and microaspiration the authors feel that the importance of dysphagia in chronic lung disease, will be increasingly recognised in frailty related microbiome exchange between the oropharynx into the lung. This review therefore discusses interconnections in the human microbiome, with a focus on the potential for aerodigestive pathophysiology and microaspiration. Potential connections with human lung disease are discussed and contextualised within a developing literature. This review therefore highlights much needed new targets for translational intervention in lung pathophysiology and underlies the importance of a mixed disciplinary team approach for the future.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48285147","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}
Objective: The goal of this review is to summarize and discuss the role of endoscopic ultrasound (EUS) in the staging and diagnosis of esophageal carcinoma. Background: EUS has a well-established role in the diagnosis and staging of esophageal carcinoma. Technological advancements over the last three decades have increased the ability and utility of EUS; it is a mainstay in the workup of esophageal carcinoma. Methods: Literature review and summary of the available information relating to the use of EUS in practice, along with a review of its limitations in practice. Conclusions: The technology that underlies EUS has evolved over the last three decades. In particular, EUS plays a vital role in determining the extent of local extension of the tumor, which is defined using the T-staging system. Furthermore, it can accurately identify metastases to nearby lymph nodes and liver, and provides the capability of tissue sampling of metastatic disease with fine needle aspiration (FNA), thereby expanding its diagnostic power. As EUS has developed, it has surpassed other modalities for the purposes of both T and N staging of esophageal cancers as delineated by the American Joint Committee on Cancer/ Union for International Cancer Control (AJCC/UICC). EUS is a cornerstone in the multimodal approach to the diagnosis and staging of esophageal cancer which also includes upper endoscopy, cross-sectional imaging, positron emission tomography (PET) scanning, mediastinoscopy and laparoscopy. Limitations of EUS include operator dependence, understaging of the disease in obstructing tumors, difficulty differentiating between T2 and T3 disease, and reduced yield in patients following chemoradiation therapy.
{"title":"Endoscopic ultrasonography in esophageal carcinoma: a narrative review","authors":"Zachary E. Daitch, S. Heller","doi":"10.21037/aoe-21-25","DOIUrl":"https://doi.org/10.21037/aoe-21-25","url":null,"abstract":"Objective: The goal of this review is to summarize and discuss the role of endoscopic ultrasound (EUS) in the staging and diagnosis of esophageal carcinoma. Background: EUS has a well-established role in the diagnosis and staging of esophageal carcinoma. Technological advancements over the last three decades have increased the ability and utility of EUS; it is a mainstay in the workup of esophageal carcinoma. Methods: Literature review and summary of the available information relating to the use of EUS in practice, along with a review of its limitations in practice. Conclusions: The technology that underlies EUS has evolved over the last three decades. In particular, EUS plays a vital role in determining the extent of local extension of the tumor, which is defined using the T-staging system. Furthermore, it can accurately identify metastases to nearby lymph nodes and liver, and provides the capability of tissue sampling of metastatic disease with fine needle aspiration (FNA), thereby expanding its diagnostic power. As EUS has developed, it has surpassed other modalities for the purposes of both T and N staging of esophageal cancers as delineated by the American Joint Committee on Cancer/ Union for International Cancer Control (AJCC/UICC). EUS is a cornerstone in the multimodal approach to the diagnosis and staging of esophageal cancer which also includes upper endoscopy, cross-sectional imaging, positron emission tomography (PET) scanning, mediastinoscopy and laparoscopy. Limitations of EUS include operator dependence, understaging of the disease in obstructing tumors, difficulty differentiating between T2 and T3 disease, and reduced yield in patients following chemoradiation therapy.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43193777","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}
{"title":"Narrative review of worldwide data on outcomes of robotic esophagectomy","authors":"E. Chan, M. V. Sanchez","doi":"10.21037/aoe-21-56","DOIUrl":"https://doi.org/10.21037/aoe-21-56","url":null,"abstract":"","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47068573","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 : 2021-01-01DOI: 10.21037/AOE-2020-EBMG-03
Katie H. A. Boulton, P. Dettmar
: Over the years gastroesophageal reflux disease (GERD) has become a common disease worldwide affecting most countries and their populations. The history of the digestive system dates back to the 1400’s and reports on how the stomach had an acidic environment. The acidity and contents of the stomach refluxing up into the esophagus was later found in some cases to cause detrimental effects to one’s health. The earliest reports of reflux disease began in 1935 and was described as peptic esophagus. Many GERD patients complain of reflux, which is a back flow of gastric contents from the stomach into the esophagus, throat, lungs and airways. It is knowledge in the present day that GERD has a variety of symptoms such as regurgitation, coughing and heartburn greatly impacting on an individual’s quality of life (QOL). An increased awareness of the pathology of GERD has allowed for a number of treatments and medicines to be developed, clinically evaluated and used worldwide. To gain an insight into how prevalent GERD is globally, this review will aim to report on its prevalence in different countries and regions of the world and report on the relevant causes associated with GERD. The influence of age, obesity, pregnancy, stress, smoking and alcohol on GERD will be reviewed along with the role of diet and how certain foods and drinks can trigger reflux events. Future research of the prevalence of GERD will help to educate people on lifestyle choices to manage GERD symptoms which in turn will improve quality of life and prevent GERD and GERD related diseases. GERD in GERD
{"title":"A narrative review of the prevalence of gastroesophageal reflux disease (GERD)","authors":"Katie H. A. Boulton, P. Dettmar","doi":"10.21037/AOE-2020-EBMG-03","DOIUrl":"https://doi.org/10.21037/AOE-2020-EBMG-03","url":null,"abstract":": Over the years gastroesophageal reflux disease (GERD) has become a common disease worldwide affecting most countries and their populations. The history of the digestive system dates back to the 1400’s and reports on how the stomach had an acidic environment. The acidity and contents of the stomach refluxing up into the esophagus was later found in some cases to cause detrimental effects to one’s health. The earliest reports of reflux disease began in 1935 and was described as peptic esophagus. Many GERD patients complain of reflux, which is a back flow of gastric contents from the stomach into the esophagus, throat, lungs and airways. It is knowledge in the present day that GERD has a variety of symptoms such as regurgitation, coughing and heartburn greatly impacting on an individual’s quality of life (QOL). An increased awareness of the pathology of GERD has allowed for a number of treatments and medicines to be developed, clinically evaluated and used worldwide. To gain an insight into how prevalent GERD is globally, this review will aim to report on its prevalence in different countries and regions of the world and report on the relevant causes associated with GERD. The influence of age, obesity, pregnancy, stress, smoking and alcohol on GERD will be reviewed along with the role of diet and how certain foods and drinks can trigger reflux events. Future research of the prevalence of GERD will help to educate people on lifestyle choices to manage GERD symptoms which in turn will improve quality of life and prevent GERD and GERD related diseases. GERD in GERD","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48747779","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}
C. Mann, F. Berlth, E. Tagkalos, E. Hadzijusufoviç, H. Lang, P. Grimminger
: Anastomotic leakages after esophagectomy are common, yet threatening complications. Possible leakage therapy ranges from reoperation to interventional treatments like stent placement or endoscopic vacuum therapy (EVAC) supported by optimized conservative therapy, ideally at an intensive care unit. Since reoperation is concomitant with high mortality, conservative and interventional therapies are applied on a frequent basis nowadays. Apart from the well-established endoscopic placement of a self-expanding-metal stent (SEMS), the EVAC has been successfully implemented in many centers in recent years. Using the same principles as subcutaneous vacuum therapy, it offers many advantages such as simultaneous drainage therapy and faster healing process. The healing process is supported by controlling the infection of the wound, promoting macro- and microdeformation of the adjacent tissue, and improvement of perfusion. Still, clear evidence about superiority of one interventional therapy strategy—either SEMS or EVAC—is lacking. This article describes the principle and the procedure of EVAC for anastomotic leakages. Current literature regarding efficiency, safety, and possible costs in comparison to SEMS therapy is reviewed. Considering the advantages EVAC therapy is offering, its value for anastomotic leakage therapy is clear. However, to reach standardized clinical application, additional research to improve the applicability and economic efficiency should be conducted.
{"title":"Endoscopic management of complications—endovacuum for management of anastomotic leakages: a narrative review","authors":"C. Mann, F. Berlth, E. Tagkalos, E. Hadzijusufoviç, H. Lang, P. Grimminger","doi":"10.21037/AOE-21-16","DOIUrl":"https://doi.org/10.21037/AOE-21-16","url":null,"abstract":": Anastomotic leakages after esophagectomy are common, yet threatening complications. Possible leakage therapy ranges from reoperation to interventional treatments like stent placement or endoscopic vacuum therapy (EVAC) supported by optimized conservative therapy, ideally at an intensive care unit. Since reoperation is concomitant with high mortality, conservative and interventional therapies are applied on a frequent basis nowadays. Apart from the well-established endoscopic placement of a self-expanding-metal stent (SEMS), the EVAC has been successfully implemented in many centers in recent years. Using the same principles as subcutaneous vacuum therapy, it offers many advantages such as simultaneous drainage therapy and faster healing process. The healing process is supported by controlling the infection of the wound, promoting macro- and microdeformation of the adjacent tissue, and improvement of perfusion. Still, clear evidence about superiority of one interventional therapy strategy—either SEMS or EVAC—is lacking. This article describes the principle and the procedure of EVAC for anastomotic leakages. Current literature regarding efficiency, safety, and possible costs in comparison to SEMS therapy is reviewed. Considering the advantages EVAC therapy is offering, its value for anastomotic leakage therapy is clear. However, to reach standardized clinical application, additional research to improve the applicability and economic efficiency should be conducted.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44791183","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}
: Salvage esophageal resection after chemoradiation is an increasingly recognized clinical challenge, especially in the context of esophageal squamous cell carcinoma. Despite that, there have been varying definitions of salvage in the literature, leading to difficulties in interpreting data. This is further complicated by the limitations in assessing clinical complete response after chemoradiation. At the same time, salvage esophagectomy has classically been approached with reservation because of the associated morbidity and mortality, especially that definitive chemoradiation is sometimes the preferred choice of treatment for borderline-operable and borderline-resectable patients. While some reports have shown good survival outcomes, others have shown the opposite. Yet, the morbidity rate remains relatively high. From a surgical point of view, borderline-operable patients can be further optimized with specialized prehabilitation programs, which have been demonstrated to be useful in gastroesophageal cancers. Intraoperatively, there are important technical modifications that need to be taken into consideration. A special consideration should also be given to patients with limited airway involvement. In this review, we explore the different definitions of salvage and discuss clinical complete response after chemoradiation. We also discuss the postoperative and survival outcomes of salvage esophagectomy. A special focus is given to preoperative optimization and intraoperative technical aspects, including airway resection. Finally, the ongoing clinical trials looking into this subject are discussed.
{"title":"Salvage surgery after definitive chemoradiotherapy for esophageal cancer","authors":"Yaseen Al Lawati, L. Ferri","doi":"10.21037/aoe-2020-10","DOIUrl":"https://doi.org/10.21037/aoe-2020-10","url":null,"abstract":": Salvage esophageal resection after chemoradiation is an increasingly recognized clinical challenge, especially in the context of esophageal squamous cell carcinoma. Despite that, there have been varying definitions of salvage in the literature, leading to difficulties in interpreting data. This is further complicated by the limitations in assessing clinical complete response after chemoradiation. At the same time, salvage esophagectomy has classically been approached with reservation because of the associated morbidity and mortality, especially that definitive chemoradiation is sometimes the preferred choice of treatment for borderline-operable and borderline-resectable patients. While some reports have shown good survival outcomes, others have shown the opposite. Yet, the morbidity rate remains relatively high. From a surgical point of view, borderline-operable patients can be further optimized with specialized prehabilitation programs, which have been demonstrated to be useful in gastroesophageal cancers. Intraoperatively, there are important technical modifications that need to be taken into consideration. A special consideration should also be given to patients with limited airway involvement. In this review, we explore the different definitions of salvage and discuss clinical complete response after chemoradiation. We also discuss the postoperative and survival outcomes of salvage esophagectomy. A special focus is given to preoperative optimization and intraoperative technical aspects, including airway resection. Finally, the ongoing clinical trials looking into this subject are discussed.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42528709","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}
Matias Turchi, Federico Llanos, Mauricio Ramirez, Franco Badaloni, F. Nachman, A. Nieponice
{"title":"Relay therapy with endovac and endoscopic stents for anastomotic leaks after minimally invasive esophagectomy","authors":"Matias Turchi, Federico Llanos, Mauricio Ramirez, Franco Badaloni, F. Nachman, A. Nieponice","doi":"10.21037/aoe-21-44","DOIUrl":"https://doi.org/10.21037/aoe-21-44","url":null,"abstract":"","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42376198","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 : 2021-01-01DOI: 10.21037/AOE-2020-MTEC-07
M. Chevallay, M. Jung, Charles-Henri Wassmer, S. Mönig
Metastatic cancer of the esophagus has a poor prognosis. For many years, surgery had no place in their management and chemo(radio)therapy was the only therapy. In patients with metastatic colon and breast cancer, surgical resection of the metastases was shown to improve long term outcomes. For the upper digestive tract, metastasectomy was first described in gastric cancer. This led to the introduction of surgery for metastatic esophageal cancer. With the progress in chemo(radio)therapy regimens and surgical techniques, complete resection of all disease has become possible particularly in patients with oligometastases. To achieve a survival advantage, obtaining a negative resection margin of the metastases is essential. Preoperative workup should therefore focus on the possibility of a complete resection. Patient selection is crucial and should be discussed in multidisciplinary tumor boards. Prognostic scores exist and can be used to predict the survival of these patients. In this review, studies on the surgical management of synchronous metastases of esophageal cancer are discussed. The results of ongoing randomized trials will help clarify if there is truly a place for surgery for synchronous metastatic disease.
{"title":"Role of surgery in the management of synchronous metastatic esophageal cancer","authors":"M. Chevallay, M. Jung, Charles-Henri Wassmer, S. Mönig","doi":"10.21037/AOE-2020-MTEC-07","DOIUrl":"https://doi.org/10.21037/AOE-2020-MTEC-07","url":null,"abstract":"Metastatic cancer of the esophagus has a poor prognosis. For many years, surgery had no place in their management and chemo(radio)therapy was the only therapy. In patients with metastatic colon and breast cancer, surgical resection of the metastases was shown to improve long term outcomes. For the upper digestive tract, metastasectomy was first described in gastric cancer. This led to the introduction of surgery for metastatic esophageal cancer. With the progress in chemo(radio)therapy regimens and surgical techniques, complete resection of all disease has become possible particularly in patients with oligometastases. To achieve a survival advantage, obtaining a negative resection margin of the metastases is essential. Preoperative workup should therefore focus on the possibility of a complete resection. Patient selection is crucial and should be discussed in multidisciplinary tumor boards. Prognostic scores exist and can be used to predict the survival of these patients. In this review, studies on the surgical management of synchronous metastases of esophageal cancer are discussed. The results of ongoing randomized trials will help clarify if there is truly a place for surgery for synchronous metastatic disease.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41534506","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}
: We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT), focusing on the surgical anatomical challenge. GERD with SIT is a very rare condition, and because of its extremely low prevalence, it presents a once-in-a-lifetime challenge for the gastroesophageal surgeon. A laparoscopic approach with minimum modifications enabled us to perform surgery as in patients with normal anatomy. In this article we describe in detail how we adapted the surgical technique to the anatomic alteration, so it can be reproduced elsewhere. We share our experience and the challenges we encountered, with the objective to give insight to a surgeon confronting a similar scenario. This is the case of a 65-year-old female, with hiatal hernia, GERD symptoms, and chronic obstructive pulmonary disease (COPD) exacerbations, which required continuous treatment adjustment. After proper evaluation, we performed a hiatoplasty and laparoscopic floppy Nissen, with only surgical ports placement modifications. We found few difficulties during surgery and a swift and ergonomic dissection for the right-handed surgeon. The patient was discharged on the second day after tolerating oral feeds. After 6 months, the patient remains asymptomatic without further COPD exacerbations. To the best of our knowledge, we present which is possibly the first reported case of a laparoscopic Nissen fundoplication in SIT in Latin America.
{"title":"Laparoscopic Nissen fundoplication for gastroesophageal reflux disease in situs inversus totalis: a “self-solving puzzle”—a case report","authors":"L. Antozzi, P. Renda","doi":"10.21037/AOE-20-63","DOIUrl":"https://doi.org/10.21037/AOE-20-63","url":null,"abstract":": We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT), focusing on the surgical anatomical challenge. GERD with SIT is a very rare condition, and because of its extremely low prevalence, it presents a once-in-a-lifetime challenge for the gastroesophageal surgeon. A laparoscopic approach with minimum modifications enabled us to perform surgery as in patients with normal anatomy. In this article we describe in detail how we adapted the surgical technique to the anatomic alteration, so it can be reproduced elsewhere. We share our experience and the challenges we encountered, with the objective to give insight to a surgeon confronting a similar scenario. This is the case of a 65-year-old female, with hiatal hernia, GERD symptoms, and chronic obstructive pulmonary disease (COPD) exacerbations, which required continuous treatment adjustment. After proper evaluation, we performed a hiatoplasty and laparoscopic floppy Nissen, with only surgical ports placement modifications. We found few difficulties during surgery and a swift and ergonomic dissection for the right-handed surgeon. The patient was discharged on the second day after tolerating oral feeds. After 6 months, the patient remains asymptomatic without further COPD exacerbations. To the best of our knowledge, we present which is possibly the first reported case of a laparoscopic Nissen fundoplication in SIT in Latin America.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49536804","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}
Kohei Kanamori, K. Koyanagi, S. Ozawa, Miho Yamamoto, Y. Ninomiya, K. Yatabe, T. Higuchi, K. Tajima
Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan Contributions: (I) Conception and design: K Kanamori, K Koyanagi; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Kazuo Koyanagi. Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. Email: kkoyanagi@tsc.u-tokai.ac.jp.
日本石原东海大学医学院消化外科贡献:(1)构思与设计:K Kanamori, K Koyanagi;行政支助:无;(三)提供研究材料或患者:无;(四)数据收集和汇编:所有作者;(五)数据分析和解释:所有作者;(六)稿件撰写:全体作者;(七)稿件最终审定:全体作者。通讯对象:Kazuo Koyanagi。东海大学医学院消化外科，神奈川县石原下笠屋143号，日本，259-1193电子邮件:kkoyanagi@tsc.u-tokai.ac.jp。
{"title":"Multimodal therapy for esophageal squamous cell carcinoma according to TNM staging in Japan—a narrative review of clinical trials conducted by Japan Clinical Oncology Group","authors":"Kohei Kanamori, K. Koyanagi, S. Ozawa, Miho Yamamoto, Y. Ninomiya, K. Yatabe, T. Higuchi, K. Tajima","doi":"10.21037/aoe-21-22","DOIUrl":"https://doi.org/10.21037/aoe-21-22","url":null,"abstract":"Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan Contributions: (I) Conception and design: K Kanamori, K Koyanagi; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Kazuo Koyanagi. Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. Email: kkoyanagi@tsc.u-tokai.ac.jp.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48867256","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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