Marialuisa Lugaresi, B. Mattioli, Niccolò Daddi, V. Pilotti, L. Ferruzzi, G. Raulli, D. Malvi, A. D’Errico, R. Fiocca, S. Mattioli
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; Division of Thoracic Surgery, Maria Cecilia Hospital, GVM Care & Research Group, Via Corriera 1, 48033 Cotignola (RA), Italy; AUSL Area Vasta Romagna, Viale V. Randi, 5, 48121 Ravenna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; Department of Surgical and Diagnostic Sciences (DISC), University of Genova and IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy Contributions: (I) Conception and design: S Mattioli; (II) Administrative support: M Lugaresi; (III) Provision of study materials or patients: V Pilotti, L Ferruzzi; (IV) Collection and assembly of data: A D’Errico, R Fiocca, D Malvi, G Raulli, B Mattioli, N Daddi; (V) Data analysis and interpretation: M Lugaresi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Prof. Sandro Mattioli. Department of Medical and Surgical Sciences (DIMEC) Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. Email: sandro.mattioli@unibo.it.
博洛尼亚大学医学院和外科科学系，意大利博洛尼亚马萨伦蒂大道9号，40138;Maria Cecilia医院，GVM护理与研究小组，Via Corriera 1,48033 Cotignola (RA)，意大利;意大利拉文纳，Viale V. Randi, 5,48121;博洛尼亚大学实验、诊断和专科医学系，意大利博洛尼亚马萨伦蒂大道9号，40138;热那亚大学外科和诊断科学系(DISC)和IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132热那亚，意大利贡献:(I)构思和设计:S Mattioli;行政支助:卢加雷斯先生;(三)提供研究材料或患者:V Pilotti, L Ferruzzi;(四)数据收集和汇编:A D 'Errico, R Fiocca, D Malvi, G Raulli, B Mattioli, N Daddi;数据分析和解释:Lugaresi先生;(六)稿件撰写:全体作者;(七)稿件最终审定:全体作者。通讯:Sandro Mattioli教授。博洛尼亚大学医学和外科科学系(DIMEC)母校工作室，Via Massarenti 9,40138博洛尼亚，意大利。电子邮件:sandro.mattioli@unibo.it。
{"title":"Total gastrectomy versus upper pole gastrectomy for the surgical therapy of Siewert type II adenocarcinoma of the esophagus: pathology may drive the choice","authors":"Marialuisa Lugaresi, B. Mattioli, Niccolò Daddi, V. Pilotti, L. Ferruzzi, G. Raulli, D. Malvi, A. D’Errico, R. Fiocca, S. Mattioli","doi":"10.21037/AOE-2020-13","DOIUrl":"https://doi.org/10.21037/AOE-2020-13","url":null,"abstract":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; Division of Thoracic Surgery, Maria Cecilia Hospital, GVM Care & Research Group, Via Corriera 1, 48033 Cotignola (RA), Italy; AUSL Area Vasta Romagna, Viale V. Randi, 5, 48121 Ravenna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; Department of Surgical and Diagnostic Sciences (DISC), University of Genova and IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy Contributions: (I) Conception and design: S Mattioli; (II) Administrative support: M Lugaresi; (III) Provision of study materials or patients: V Pilotti, L Ferruzzi; (IV) Collection and assembly of data: A D’Errico, R Fiocca, D Malvi, G Raulli, B Mattioli, N Daddi; (V) Data analysis and interpretation: M Lugaresi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Prof. Sandro Mattioli. Department of Medical and Surgical Sciences (DIMEC) Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. Email: sandro.mattioli@unibo.it.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46433425","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}
Balázs Kovács, T. Masuda, R. Bremner, Michael A. Smith, Jasmine L. Huang, A. Hashimi, Chirag Patel, Shair Ahmed, S. Mittal
Background: Esophageal perforation is associated with high morbidity and mortality. The aim of this study was to evaluate the outcomes of patients who underwent treatment for esophageal perforation at a tertiary referral hospital. Methods: A patient database was queried for patients treated for esophageal perforation between May 2014 and September 2017. Charts were retrospectively reviewed. The Pittsburgh perforation severity score (PSS) was calculated to assess the degree of perforation severity for each patient. Results: In total, 56 patients with esophageal perforation met inclusion criteria for this study. Thirty-nine patients (69.6%) were men, the mean age of the patients was 60 years. The most common causes of esophageal perforation were iatrogenic (24/56, 42.9%) and Boerhaave syndrome (12/56, 21.4%). The most common site of perforation was the thoracic esophagus (38/56, 67.9%). Eight patients were treated conservatively, a stent-only approach was used in 8 patients, and 40 patients underwent surgery. Seventeen/40 of these patients underwent debridement and drainage; 8 of those 17 also received stenting of the perforation site. Primary repair was used in 16 patients. Of these 16 patients, 2 also received a stent. Seven patients underwent esophagectomy. Overall mortality within 1 month was 5.4% (3 patients); this was similar to the predicted value. Subgroup comparison failed to reveal a significant advantage of stent use. Conclusions: The leading causes of esophageal perforation were iatrogenic injury and Boerhaave syndrome. The Pittsburgh PSS correlated well with the need for aggressive surgical intervention and length of stay in the intensive care unit.
{"title":"Esophageal perforation: a retrospective report of outcomes at a single center","authors":"Balázs Kovács, T. Masuda, R. Bremner, Michael A. Smith, Jasmine L. Huang, A. Hashimi, Chirag Patel, Shair Ahmed, S. Mittal","doi":"10.21037/AOE-20-17","DOIUrl":"https://doi.org/10.21037/AOE-20-17","url":null,"abstract":"Background: Esophageal perforation is associated with high morbidity and mortality. The aim of this study was to evaluate the outcomes of patients who underwent treatment for esophageal perforation at a tertiary referral hospital. Methods: A patient database was queried for patients treated for esophageal perforation between May 2014 and September 2017. Charts were retrospectively reviewed. The Pittsburgh perforation severity score (PSS) was calculated to assess the degree of perforation severity for each patient. Results: In total, 56 patients with esophageal perforation met inclusion criteria for this study. Thirty-nine patients (69.6%) were men, the mean age of the patients was 60 years. The most common causes of esophageal perforation were iatrogenic (24/56, 42.9%) and Boerhaave syndrome (12/56, 21.4%). The most common site of perforation was the thoracic esophagus (38/56, 67.9%). Eight patients were treated conservatively, a stent-only approach was used in 8 patients, and 40 patients underwent surgery. Seventeen/40 of these patients underwent debridement and drainage; 8 of those 17 also received stenting of the perforation site. Primary repair was used in 16 patients. Of these 16 patients, 2 also received a stent. Seven patients underwent esophagectomy. Overall mortality within 1 month was 5.4% (3 patients); this was similar to the predicted value. Subgroup comparison failed to reveal a significant advantage of stent use. Conclusions: The leading causes of esophageal perforation were iatrogenic injury and Boerhaave syndrome. The Pittsburgh PSS correlated well with the need for aggressive surgical intervention and length of stay in the intensive care unit.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41426554","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":"Bile acids are risk factors for esophageal carcinogenesis","authors":"N. Hashimoto","doi":"10.21037/AOE-20-99","DOIUrl":"https://doi.org/10.21037/AOE-20-99","url":null,"abstract":"","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49418582","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 purpose of this review is to familiarize the reader with endoscopic resection (ER) options for early-stage esophageal cancers. Background: Esophageal cancer consists of squamous cell carcinoma (SCC) and adenocarcinoma (EAC) and is associated with significant worldwide morbidity and mortality. People who are diagnosed after the development of symptoms, such as dysphagia, typically have more advanced tumor stages and poorer long-term outcomes. surgical esophagectomy is a historic gold standard curative treatment for patients with esophageal cancer. Endoscopic screening and surveillance in at-risk patients, such as those with Barrett’s esophagus, allows detection of esophageal cancer at an earlier stage. Recent developments in endoscopic techniques allow endoscopic removal of very early stage esophageal cancers, sparing some patients the need for esophagectomy, which harbors significant morbidity and mortality. Methods: An electronic search and data extraction of literature from inception was performed to present a narrative review on the endoscopic management of early esophageal cancer. Conclusions: The goal for curative surgical management of esophageal tumors is to achieve an R0 en bloc resection. The earliest stages of esophageal cancer (carcinoma-in-situ, moderately-to-well differentiated pT1a carcinomas without lymphatic or vascular invasion) of are now increasingly treated with ER techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). These effective resection techniques offer an additional curative treatment option for carefully selected patients. However, ER is only curative in patients without locoregional or distant metastatic disease. In this review we discuss the different approaches to endoscopic management of early esophageal cancer.
{"title":"Endoscopic management of early esophageal cancer: a literature review","authors":"P. Wander, Jeffrey L. Tokar","doi":"10.21037/aoe-21-30","DOIUrl":"https://doi.org/10.21037/aoe-21-30","url":null,"abstract":"Objective: The purpose of this review is to familiarize the reader with endoscopic resection (ER) options for early-stage esophageal cancers. Background: Esophageal cancer consists of squamous cell carcinoma (SCC) and adenocarcinoma (EAC) and is associated with significant worldwide morbidity and mortality. People who are diagnosed after the development of symptoms, such as dysphagia, typically have more advanced tumor stages and poorer long-term outcomes. surgical esophagectomy is a historic gold standard curative treatment for patients with esophageal cancer. Endoscopic screening and surveillance in at-risk patients, such as those with Barrett’s esophagus, allows detection of esophageal cancer at an earlier stage. Recent developments in endoscopic techniques allow endoscopic removal of very early stage esophageal cancers, sparing some patients the need for esophagectomy, which harbors significant morbidity and mortality. Methods: An electronic search and data extraction of literature from inception was performed to present a narrative review on the endoscopic management of early esophageal cancer. Conclusions: The goal for curative surgical management of esophageal tumors is to achieve an R0 en bloc resection. The earliest stages of esophageal cancer (carcinoma-in-situ, moderately-to-well differentiated pT1a carcinomas without lymphatic or vascular invasion) of are now increasingly treated with ER techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). These effective resection techniques offer an additional curative treatment option for carefully selected patients. However, ER is only curative in patients without locoregional or distant metastatic disease. In this review we discuss the different approaches to endoscopic management of early esophageal cancer.","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":"42340217","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":"Robotic-assisted repair of post-esophagectomy hiatal hernia: case report and review of technique","authors":"Ammara A Watkins, C. Stock, E. Servais","doi":"10.21037/aoe-21-49","DOIUrl":"https://doi.org/10.21037/aoe-21-49","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":"43014194","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}
P. Garcia, S. Mattessich, R. Sao, Jun Lu, Houman Rezaizadeh
: Mucous membrane pemphigoid (MMP) is a chronic, autoimmune, subepithelial blistering disease with a predilection for mucosal surfaces. Patients often present with lesions in more than one site, including the mouth, eyelids, scalp, genitals, larynx, or esophagus. The evolution of active erosions into scars is the hallmark of this disease, which leads to loss of tissue function and increased patient morbidity. Esophageal involvement is seen in about 2–7% patients with MMP and can result in debilitating esophageal strictures and stenosis requiring intermittent, and often frequent, esophageal dilation. Typically, esophageal disease activity coincides with dermatologic activity and therefore management is primarily driven by Dermatology. Though there is no definitive treatment for MMP, symptomatic treatment is accomplished with use of immune therapies including systemic steroids. We present a case of MMP with persistent dysphagia despite escalation of immunosuppression which was adequate enough to successfully treat dermatologic manifestation of MMP. Despite maximizing systemic treatment of MMP and multiple repeated endoscopic esophageal dilations, our patients esophageal MMP and dysphagia persisted. Ultimately, with the addition of swallowed fluticasone as a result of Dermatology and Gastroenterology co-management, the patient achieved complete response. To the best of our knowledge, our case is the first to describe the use of swallowed steroids (fluticasone or budesonide) in a patient with refractory esophageal MMP. 5
{"title":"Multidisciplinary management of persistent dysphagia in mucous membrane pemphigoid: a case report","authors":"P. Garcia, S. Mattessich, R. Sao, Jun Lu, Houman Rezaizadeh","doi":"10.21037/aoe-20-24","DOIUrl":"https://doi.org/10.21037/aoe-20-24","url":null,"abstract":": Mucous membrane pemphigoid (MMP) is a chronic, autoimmune, subepithelial blistering disease with a predilection for mucosal surfaces. Patients often present with lesions in more than one site, including the mouth, eyelids, scalp, genitals, larynx, or esophagus. The evolution of active erosions into scars is the hallmark of this disease, which leads to loss of tissue function and increased patient morbidity. Esophageal involvement is seen in about 2–7% patients with MMP and can result in debilitating esophageal strictures and stenosis requiring intermittent, and often frequent, esophageal dilation. Typically, esophageal disease activity coincides with dermatologic activity and therefore management is primarily driven by Dermatology. Though there is no definitive treatment for MMP, symptomatic treatment is accomplished with use of immune therapies including systemic steroids. We present a case of MMP with persistent dysphagia despite escalation of immunosuppression which was adequate enough to successfully treat dermatologic manifestation of MMP. Despite maximizing systemic treatment of MMP and multiple repeated endoscopic esophageal dilations, our patients esophageal MMP and dysphagia persisted. Ultimately, with the addition of swallowed fluticasone as a result of Dermatology and Gastroenterology co-management, the patient achieved complete response. To the best of our knowledge, our case is the first to describe the use of swallowed steroids (fluticasone or budesonide) in a patient with refractory esophageal MMP. 5","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":"48601098","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}
V. Porziella, D. Tabacco, E. Zanfrini, Jessica Evangelista, M. Vita, L. Petracca-Ciavarella, L. Pogliani, E. Meacci, M. Congedo, M. Chiappetta, S. Margaritora, D. Nachira
: Stricture of the esophagus is the most frequent late sequelae of the ingestion of caustic agents. It is disabling, lead to chronic pain and malnutrition. Endoscopic dilatation still remains the first-line management but cannot be effective in all patients. When surgery is indicated, only selected patients can be submitted to an esophago-gastroplasty. Colon interposition for esophageal replacement is more frequently performed for treatment of caustic burns, but many questions still remain about colonic tract to be used (right or left), route of transposition and timing of the operation. Surgeon’s experience is the most important factor to choose the right colonic tract as esophageal substitute. Age, psychiatric disorders, massive ingestion, emergency tracheotomy, extended visceral resections, short delays in reconstruction, and pharyngeal involvement worsen surgical outcomes, therefore surgery should be performed in high-volume centers. Follow-up of these patients should not tend only to verify the patency of the transit and weight maintenance, but it should identify any lesion of the graft and any metabolic alteration referring to an altered permeability of the transposed colic segment. In this review, we present the main step of preoperative, intraoperative and postoperative pathway of esophageal reconstruction for caustic strictures with a colonic graft, critically exposed according to our experience.
{"title":"Colon interposition in the management of post-corrosive strictures","authors":"V. Porziella, D. Tabacco, E. Zanfrini, Jessica Evangelista, M. Vita, L. Petracca-Ciavarella, L. Pogliani, E. Meacci, M. Congedo, M. Chiappetta, S. Margaritora, D. Nachira","doi":"10.21037/AOE-2020-27","DOIUrl":"https://doi.org/10.21037/AOE-2020-27","url":null,"abstract":": Stricture of the esophagus is the most frequent late sequelae of the ingestion of caustic agents. It is disabling, lead to chronic pain and malnutrition. Endoscopic dilatation still remains the first-line management but cannot be effective in all patients. When surgery is indicated, only selected patients can be submitted to an esophago-gastroplasty. Colon interposition for esophageal replacement is more frequently performed for treatment of caustic burns, but many questions still remain about colonic tract to be used (right or left), route of transposition and timing of the operation. Surgeon’s experience is the most important factor to choose the right colonic tract as esophageal substitute. Age, psychiatric disorders, massive ingestion, emergency tracheotomy, extended visceral resections, short delays in reconstruction, and pharyngeal involvement worsen surgical outcomes, therefore surgery should be performed in high-volume centers. Follow-up of these patients should not tend only to verify the patency of the transit and weight maintenance, but it should identify any lesion of the graft and any metabolic alteration referring to an altered permeability of the transposed colic segment. In this review, we present the main step of preoperative, intraoperative and postoperative pathway of esophageal reconstruction for caustic strictures with a colonic graft, critically exposed according to our experience.","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":"46488131","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-06
Kyle J. Stanforth, P. Chater, I. Brownlee, M. Wilcox, C. Ward, J. Pearson
This review discusses the utility and limitations of model gut systems in accurately modelling the mucosa of the digestive tract from both an anatomical and functional perspective, with a particular focus on the oesophagus and the upper digestive tract, and what this means for effective in vitro modelling of oesophageal pathology. Disorders of the oesophagus include heartburn, dysphagia, eosinophilic oesophagitis, achalasia, oesophageal spasm and gastroesophageal reflux disease. 3D in vitro models of the oesophagus, such as organotypic 3D culture and spheroid culture, have been shown to be effective tools for investigating oesophageal pathology. However, these models are not integrated with modelling of the upper digestive tract—presenting an opportunity for future development. Reflux of upper gastrointestinal contents is a major contributor to oesophageal pathologies like gastroesophageal reflux disease and Barratt’s oesophagus, and in vitro models are essential for understanding their mechanisms and developing solutions. The limitations of current model gut systems in modelling the mucosa is not only limited to the oesophagus. Integration of modelling of the mucus covered epithelia of the stomach and small intestine in to upper digestive tract models is limited and often not considered at all. In this paper we discuss mucus structure and function and current approaches to modelling of the mucus layer in isolation, and in integrated systems with cell culture systems and digestive models. We identify a need for relevant modelling of the viscoelastic properties of mucus and its protective function to allow complete integration in modelling. Addressing limitations of current in vitro models and integrating upper gastrointestinal models with those of the oesophagus presents an opportunity for better understanding oesophageal physiology and pathophysiology where reflux of digestive fluids is involved.
{"title":"In vitro modelling of the mucosa of the oesophagus and upper digestive tract","authors":"Kyle J. Stanforth, P. Chater, I. Brownlee, M. Wilcox, C. Ward, J. Pearson","doi":"10.21037/AOE-2020-EBMG-06","DOIUrl":"https://doi.org/10.21037/AOE-2020-EBMG-06","url":null,"abstract":"This review discusses the utility and limitations of model gut systems in accurately modelling the mucosa of the digestive tract from both an anatomical and functional perspective, with a particular focus on the oesophagus and the upper digestive tract, and what this means for effective in vitro modelling of oesophageal pathology. Disorders of the oesophagus include heartburn, dysphagia, eosinophilic oesophagitis, achalasia, oesophageal spasm and gastroesophageal reflux disease. 3D in vitro models of the oesophagus, such as organotypic 3D culture and spheroid culture, have been shown to be effective tools for investigating oesophageal pathology. However, these models are not integrated with modelling of the upper digestive tract—presenting an opportunity for future development. Reflux of upper gastrointestinal contents is a major contributor to oesophageal pathologies like gastroesophageal reflux disease and Barratt’s oesophagus, and in vitro models are essential for understanding their mechanisms and developing solutions. The limitations of current model gut systems in modelling the mucosa is not only limited to the oesophagus. Integration of modelling of the mucus covered epithelia of the stomach and small intestine in to upper digestive tract models is limited and often not considered at all. In this paper we discuss mucus structure and function and current approaches to modelling of the mucus layer in isolation, and in integrated systems with cell culture systems and digestive models. We identify a need for relevant modelling of the viscoelastic properties of mucus and its protective function to allow complete integration in modelling. Addressing limitations of current in vitro models and integrating upper gastrointestinal models with those of the oesophagus presents an opportunity for better understanding oesophageal physiology and pathophysiology where reflux of digestive fluids is involved.","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":"42935470","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}
M. Ramírez, Matias Turchi, Federico Llanos, A. Badaloni, A. Nieponice
Background: Esophagectomy has been the mainstay of curative treatment for esophageal cancer and it is the of care for patients with locally advanced esophageal cancer. Intrathoracic anastomosis is one of the most challenging steps of this procedure. Methods: In this paper, we evaluated a prospective cohort of 27 patients with distal esophageal lesions that were offered minimally invasive Ivor Lewis minimally esophagectomy with a totally hand sewn anastomosis. We introduce the first use of an articulated needle holder for thoracoscopic suturing in the same technique. Results: Mean time for anastomosis was 60 min (40–120 min). Anastomotic leakage occurred in 4 patients (14.8%). These included 1 patient (3.7%) with a type I, 2 patients (7.4%) with a type II anastomotic leak and one patient with a type III leak (2.7%). Two patients (7.4%) had type III necrosis of the conduit. Conservative management with endovac and stents was completed in 3 patients. Reoperation was required in two cases (7.4%). The mean length of stay was 9 days (7–28 days). One serious complication involving death occurred (3.7%). Five patients (18.5%) experienced dysphagia that turned out in anastomotic strictures and required endoscopic dilatation. Conclusions: Thoracoscopic hand sewn anastomosis is feasible and reproducible and has an acceptable leak and stricture rate even within the learning curve. Flexible articulated instruments are a promising tool for minimally invasive surgery in restricted space.
背景:食管癌切除术是食管癌根治性治疗的主要方法，也是局部晚期食管癌患者的首选治疗方法。胸内吻合是该手术中最具挑战性的步骤之一。方法:在本文中，我们评估了27例食管远端病变患者的前瞻性队列，这些患者采用微创Ivor Lewis微创食管切除术并完全手工缝合吻合。我们介绍了在相同的技术中首次使用铰接针架进行胸腔镜缝合。结果:吻合时间平均60 min (40 ~ 120 min)。吻合口漏4例(14.8%)。其中1例(3.7%)为I型吻合口瘘，2例(7.4%)为II型吻合口瘘，1例(2.7%)为III型吻合口瘘。2例(7.4%)为导管III型坏死。3例患者完成了腔内插管和支架的保守治疗。2例(7.4%)需再次手术。平均住院时间为9天(7 ~ 28天)。发生1例严重并发症导致死亡(3.7%)。5例患者(18.5%)出现吞咽困难，导致吻合口狭窄，需要内镜扩张。结论:胸腔镜下手缝吻合术是可行的，可重复性好，即使在学习曲线范围内也有可接受的漏狭窄率。柔性关节器械是一种很有前途的微创手术工具。
{"title":"Hand-sewn anastomosis for minimally invasive laparoscopic Ivor Lewis esophagectomy—how to do it: operative technique and short-term outcomes","authors":"M. Ramírez, Matias Turchi, Federico Llanos, A. Badaloni, A. Nieponice","doi":"10.21037/aoe-21-46","DOIUrl":"https://doi.org/10.21037/aoe-21-46","url":null,"abstract":"Background: Esophagectomy has been the mainstay of curative treatment for esophageal cancer and it is the of care for patients with locally advanced esophageal cancer. Intrathoracic anastomosis is one of the most challenging steps of this procedure. Methods: In this paper, we evaluated a prospective cohort of 27 patients with distal esophageal lesions that were offered minimally invasive Ivor Lewis minimally esophagectomy with a totally hand sewn anastomosis. We introduce the first use of an articulated needle holder for thoracoscopic suturing in the same technique. Results: Mean time for anastomosis was 60 min (40–120 min). Anastomotic leakage occurred in 4 patients (14.8%). These included 1 patient (3.7%) with a type I, 2 patients (7.4%) with a type II anastomotic leak and one patient with a type III leak (2.7%). Two patients (7.4%) had type III necrosis of the conduit. Conservative management with endovac and stents was completed in 3 patients. Reoperation was required in two cases (7.4%). The mean length of stay was 9 days (7–28 days). One serious complication involving death occurred (3.7%). Five patients (18.5%) experienced dysphagia that turned out in anastomotic strictures and required endoscopic dilatation. Conclusions: Thoracoscopic hand sewn anastomosis is feasible and reproducible and has an acceptable leak and stricture rate even within the learning curve. Flexible articulated instruments are a promising tool for minimally invasive surgery in restricted space.","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":"45754534","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-ETBE-04
C. Frederiks, Sanne N. van Munster, B. Weusten
: Barrett’s esophagus is a premalignant condition, and endoscopic eradication therapy is indicated upon development of early neoplasia. Therapy consists of endoscopic resection for visible lesions, if present, followed by endoscopic ablation for remaining flat Barrett’s epithelium. Since Barrett’s esophagus with early neoplasia in itself is asymptomatic disease, the ultimate goal of endoscopic eradication therapy is to prevent progression to advanced cancer: a disease stage with limited treatment options and a poor prognosis. The preventive nature of endoscopic treatment may give rise to debate about the preferred endpoint to pursue. Establishment of a careful balance between the benefits of endoscopic eradication therapy against its risks, such as complications and other adverse events, may help to define the optimum endpoint for each individual patient. To date, various endpoints have been used in regular practice and different endpoints are used in clinical studies. The most important differences between these endpoints are whether all visible Barrett’s epithelium is eradicated or all dysplasia and cancer; and whether the endpoint is assessed on endoscopic examination only or with histologic confirmation. In this narrative review, we aim to evaluate these different endpoints of endoscopic eradication therapy with potential advantages and limitations, and present three clinical vignettes each with a different suggestion for an appropriate treatment endpoint. 10
{"title":"Goals of endoscopic eradication therapy in Barrett’s esophagus: a narrative review","authors":"C. Frederiks, Sanne N. van Munster, B. Weusten","doi":"10.21037/AOE-2020-ETBE-04","DOIUrl":"https://doi.org/10.21037/AOE-2020-ETBE-04","url":null,"abstract":": Barrett’s esophagus is a premalignant condition, and endoscopic eradication therapy is indicated upon development of early neoplasia. Therapy consists of endoscopic resection for visible lesions, if present, followed by endoscopic ablation for remaining flat Barrett’s epithelium. Since Barrett’s esophagus with early neoplasia in itself is asymptomatic disease, the ultimate goal of endoscopic eradication therapy is to prevent progression to advanced cancer: a disease stage with limited treatment options and a poor prognosis. The preventive nature of endoscopic treatment may give rise to debate about the preferred endpoint to pursue. Establishment of a careful balance between the benefits of endoscopic eradication therapy against its risks, such as complications and other adverse events, may help to define the optimum endpoint for each individual patient. To date, various endpoints have been used in regular practice and different endpoints are used in clinical studies. The most important differences between these endpoints are whether all visible Barrett’s epithelium is eradicated or all dysplasia and cancer; and whether the endpoint is assessed on endoscopic examination only or with histologic confirmation. In this narrative review, we aim to evaluate these different endpoints of endoscopic eradication therapy with potential advantages and limitations, and present three clinical vignettes each with a different suggestion for an appropriate treatment endpoint. 10","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":"49538510","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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