: Swallowing is a physiological process organized in a sequence of events grouped in extraesophageal and esophageal phase. Changes in the swallowing mechanism can be seen in many clinical situations. Difficulties in the study of the extraesophageal phase of this mechanism occur frequently due to the velocity of this moment, compared to the esophageal phase, as well as the structural characteristics of the upper esophageal sphincter (UES). The aim of this paper is to make a literature review on current functional assessment of the UES. The authors conducted a PubMed search of research published between August 2009 and December 2020, looking for publications related to the topic studied. All diagnostic methods (imaging and endoscopic), as well as conventional manometry, present technical difficulties for their performance and interpretation of results. The emergence of high-resolution manometry (HRM) brought a great advance in the diagnostic study of the pathophysiological phenomena that affect the UES, as well as the repercussion in this location of other esophageal disorders. Functional study of UES through HRM has allowed not only a better understanding of its functioning under normal and pathological conditions, but also an increased number of situations in which it can be applied.
{"title":"A narrative review of current functional assessment of the upper esophageal sphincter","authors":"R. L. Neto, F. Herbella","doi":"10.21037/AOE-21-17","DOIUrl":"https://doi.org/10.21037/AOE-21-17","url":null,"abstract":": Swallowing is a physiological process organized in a sequence of events grouped in extraesophageal and esophageal phase. Changes in the swallowing mechanism can be seen in many clinical situations. Difficulties in the study of the extraesophageal phase of this mechanism occur frequently due to the velocity of this moment, compared to the esophageal phase, as well as the structural characteristics of the upper esophageal sphincter (UES). The aim of this paper is to make a literature review on current functional assessment of the UES. The authors conducted a PubMed search of research published between August 2009 and December 2020, looking for publications related to the topic studied. All diagnostic methods (imaging and endoscopic), as well as conventional manometry, present technical difficulties for their performance and interpretation of results. The emergence of high-resolution manometry (HRM) brought a great advance in the diagnostic study of the pathophysiological phenomena that affect the UES, as well as the repercussion in this location of other esophageal disorders. Functional study of UES through HRM has allowed not only a better understanding of its functioning under normal and pathological conditions, but also an increased number of situations in which it can be applied.","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":"49640689","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":"Introductory preface for special series: minimally invasive procedures for gastroesophageal reflux disease","authors":"G. P. Kohn","doi":"10.21037/aoe-22-7","DOIUrl":"https://doi.org/10.21037/aoe-22-7","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":"46388652","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":"Introductory preface for special series “Minimally Invasive Procedures for Gastroesophageal Reflux Disease”","authors":"T. Farrell","doi":"10.21037/aoe-22-10","DOIUrl":"https://doi.org/10.21037/aoe-22-10","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":"48650165","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}
Kelsey A Musgrove, Charlotte R. Spear, Fazil A. Abbas, Ghulam Abbas
{"title":"Per-oral endoscopic myotomy (POEM) for achalasia: techniques and outcomes","authors":"Kelsey A Musgrove, Charlotte R. Spear, Fazil A. Abbas, Ghulam Abbas","doi":"10.21037/aoe-21-47","DOIUrl":"https://doi.org/10.21037/aoe-21-47","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":"46968609","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}
Department of Surgery, Cleveland University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: Both authors; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Leena Khaitan, MD, MPH. Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Lakeside 7th Floor, Cleveland, OH 44106, USA. Email: Leena.Khaitan@uhhospitals.org.
{"title":"A narrative review of minimally invasive procedures for gastroesophageal reflux disease: endoscopic antireflux procedures (TIF and Stretta)","authors":"Michael T. Fastiggi, L. Khaitan","doi":"10.21037/aoe-21-15","DOIUrl":"https://doi.org/10.21037/aoe-21-15","url":null,"abstract":"Department of Surgery, Cleveland University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: Both authors; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Leena Khaitan, MD, MPH. Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Lakeside 7th Floor, Cleveland, OH 44106, USA. Email: Leena.Khaitan@uhhospitals.org.","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":"47097748","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}
Background: To date, there have been no studies which have considered whether treatments for achalasia are delivered equitably to different communities within a multi-ethnic society. Methods: Thirteen Trusts across England were sent Freedom of Information requests to provide information on admissions for achalasia between 2010 and 2019. Data were requested for patients of White British and South Asian ethnicity together with treatment details. Trusts which provided complete data were distinguished from those quoting numbers as <10 or <5 and results analysed separately. Treatment types were compared and correlation with deprivation sought. Results: In those Trusts which provided a detailed response there was a significant difference in the pattern of treatment between White British and South Asian patients. ( χ 2 =9.56, P<0.05). 27% of South Asian patients underwent surgical management in the form of a myotomy compared to 19% of White British patients. South Asian patients were significantly more likely to undergo a POEM procedure than White British patients (z=−3.12, P<0.01). Confirmation of a different pattern of treatment was seen in the second group of Trusts where there was a maximum of 865 admissions for treatment of achalasia. When the possible maximum number of patients treated during the decade was considered, significance was comparable ( χ 2 =7.59, P<0.05). If the minimum number of admissions of 736 was considered, then χ 2 =15.77, P<0.001. Deprivation was separately correlated with number of procedures per patient for both White British ethnicity (r s =0.733, P<0.05) and South Asian ethnicity (r s =0.686, P<0.05), indicating this was not the cause of disparate treatment. Conclusions: Patients with achalasia, who are South Asian, receive a different pattern of treatment to White British patients. They were 8% more likely to undergo a surgical form of management and 6% less likely to receive Botulinum toxin therapy. They are more likely to have a POEM procedure in inexperienced centres. In deprived communities both South Asian and White British patients are less likely to receive multiple therapies for long-term management of the disease.
背景:迄今为止，还没有研究考虑到在多民族社会中，对失弛缓症的治疗是否公平地提供给不同的社区。方法:在2010年至2019年期间，向英格兰各地的13个信托机构发送了信息自由请求，以提供贲门失弛缓症的入院信息。要求英国白人和南亚族裔患者的数据以及治疗细节。将提供完整数据的信托与引用数字<10或<5的信托区分开来，并对结果进行单独分析。比较治疗类型并寻求与剥夺的相关性。结果:在那些提供详细答复的信托机构中，英国白人和南亚患者的治疗模式有显著差异。(χ 2 =9.56, p <0.05)。27%的南亚患者接受了肌切开术的手术治疗，而英国白人患者的这一比例为19%。南亚患者比英国白人患者更有可能接受POEM手术(z= - 3.12, P<0.01)。第二组信托基金证实了一种不同的治疗模式，其中最多有865人入院治疗失弛缓症。考虑10年内可能的最大治疗人数，差异具有可比性(χ 2 =7.59, P<0.05)。如果考虑最小入院人数736人，则χ 2 =15.77, P<0.001。剥夺分别与英国白人(r s =0.733, P<0.05)和南亚种族(r s =0.686, P<0.05)的每位患者的手术次数相关，表明这不是导致不同治疗的原因。结论:南亚贲门失弛缓症患者接受的治疗模式与英国白人患者不同。他们接受手术治疗的可能性增加8%，接受肉毒杆菌毒素治疗的可能性减少6%。他们更有可能在没有经验的中心进行POEM手术。在贫困社区，南亚和英国白人患者都不太可能接受多种长期治疗。
{"title":"Original observational study on disparate treatments for achalasia experienced by patients of white British and South Asian ethnicity","authors":"A. Farrukh, J. Mayberry","doi":"10.21037/AOE-20-72","DOIUrl":"https://doi.org/10.21037/AOE-20-72","url":null,"abstract":"Background: To date, there have been no studies which have considered whether treatments for achalasia are delivered equitably to different communities within a multi-ethnic society. Methods: Thirteen Trusts across England were sent Freedom of Information requests to provide information on admissions for achalasia between 2010 and 2019. Data were requested for patients of White British and South Asian ethnicity together with treatment details. Trusts which provided complete data were distinguished from those quoting numbers as <10 or <5 and results analysed separately. Treatment types were compared and correlation with deprivation sought. Results: In those Trusts which provided a detailed response there was a significant difference in the pattern of treatment between White British and South Asian patients. ( χ 2 =9.56, P<0.05). 27% of South Asian patients underwent surgical management in the form of a myotomy compared to 19% of White British patients. South Asian patients were significantly more likely to undergo a POEM procedure than White British patients (z=−3.12, P<0.01). Confirmation of a different pattern of treatment was seen in the second group of Trusts where there was a maximum of 865 admissions for treatment of achalasia. When the possible maximum number of patients treated during the decade was considered, significance was comparable ( χ 2 =7.59, P<0.05). If the minimum number of admissions of 736 was considered, then χ 2 =15.77, P<0.001. Deprivation was separately correlated with number of procedures per patient for both White British ethnicity (r s =0.733, P<0.05) and South Asian ethnicity (r s =0.686, P<0.05), indicating this was not the cause of disparate treatment. Conclusions: Patients with achalasia, who are South Asian, receive a different pattern of treatment to White British patients. They were 8% more likely to undergo a surgical form of management and 6% less likely to receive Botulinum toxin therapy. They are more likely to have a POEM procedure in inexperienced centres. In deprived communities both South Asian and White British patients are less likely to receive multiple therapies for long-term management of the 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":"45433974","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}
: Barrett’s esophagus (BE) is a well-known risk factor for the development of esophageal adenocarcinoma (EAC). This histologic transformation occurs in a stepwise fashion with progression from intestinal metaplasia (IM) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), intramucosal adenocarcinoma (IMCA), and ultimately invasive EAC. Standardized guidelines have been developed for screening, surveillance and treatment of dysplastic/neoplastic BE. Endoscopic eradication therapy (EET) is recommended over esophagectomy for dysplasia and early (mucosal) neoplasia based on its efficacy and favorable risk profile. EET consists of endoscopic resection of any nodular lesions followed by endoscopic ablation of Barrett’s mucosa. Endoscopic resection can be performed by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). There are several effective modalities available for endoscopic ablation including radiofrequency ablation (RFA), cryoablation, argon plasma coagulation (APC), and/ or hybrid-APC. Often times, multimodal endoscopic therapy is utilized with a combination of endoscopic resection and ablation techniques. While generally well tolerated, complications from these therapeutic procedures do occur, including sedation-related events, post-procedure chest pain, luminal perforation, bleeding and esophageal stricture. Complications may occur intraprocedure, immediately post-procedure, or delayed post-procedure. Treatment depends upon the severity of the complication, hemodynamic stability of the patient, and timing of presentation. This review highlights the potential complications associated with BE endotherapy and the management thereof.
{"title":"Endoscopic therapy for Barrett’s esophagus: a narrative review of potential complications and their management","authors":"Sarah Enslin, R. Tariq, V. Kaul","doi":"10.21037/AOE-20-96","DOIUrl":"https://doi.org/10.21037/AOE-20-96","url":null,"abstract":": Barrett’s esophagus (BE) is a well-known risk factor for the development of esophageal adenocarcinoma (EAC). This histologic transformation occurs in a stepwise fashion with progression from intestinal metaplasia (IM) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), intramucosal adenocarcinoma (IMCA), and ultimately invasive EAC. Standardized guidelines have been developed for screening, surveillance and treatment of dysplastic/neoplastic BE. Endoscopic eradication therapy (EET) is recommended over esophagectomy for dysplasia and early (mucosal) neoplasia based on its efficacy and favorable risk profile. EET consists of endoscopic resection of any nodular lesions followed by endoscopic ablation of Barrett’s mucosa. Endoscopic resection can be performed by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). There are several effective modalities available for endoscopic ablation including radiofrequency ablation (RFA), cryoablation, argon plasma coagulation (APC), and/ or hybrid-APC. Often times, multimodal endoscopic therapy is utilized with a combination of endoscopic resection and ablation techniques. While generally well tolerated, complications from these therapeutic procedures do occur, including sedation-related events, post-procedure chest pain, luminal perforation, bleeding and esophageal stricture. Complications may occur intraprocedure, immediately post-procedure, or delayed post-procedure. Treatment depends upon the severity of the complication, hemodynamic stability of the patient, and timing of presentation. This review highlights the potential complications associated with BE endotherapy and the management thereof.","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":"45978583","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}
Gastro-esophageal reflux disease (GERD or reflux disease) is defined by the Montreal consensus as a condition that develops when the reflux of gastric content into the esophagus causes troublesome symptoms or complications (1). According to a review by Nirwan et al., GERD has a global prevalence of 14% with significant variations between regions and countries. Whilst the prevalence of GERD in Australia and the United Kingdom is 10–15%, the prevalence in the United States of America is higher, at 30–35% (2). Laparoscopic anti-reflux surgery is an accepted Review Article
{"title":"Choosing the right patient for laparoscopic fundoplication: a narrative review of preoperative predictors","authors":"Rippan N. Shukla, J. Myers, S. Thompson","doi":"10.21037/AOE-21-19","DOIUrl":"https://doi.org/10.21037/AOE-21-19","url":null,"abstract":"Gastro-esophageal reflux disease (GERD or reflux disease) is defined by the Montreal consensus as a condition that develops when the reflux of gastric content into the esophagus causes troublesome symptoms or complications (1). According to a review by Nirwan et al., GERD has a global prevalence of 14% with significant variations between regions and countries. Whilst the prevalence of GERD in Australia and the United Kingdom is 10–15%, the prevalence in the United States of America is higher, at 30–35% (2). Laparoscopic anti-reflux surgery is an accepted Review Article","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":"43927995","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":"Monitoring for achieving the curative resection of superficial esophageal carcinoma after endoscopic submucosal dissection","authors":"T. Iizuka, K. Kawamoto, Satomi Shibata, K. Momma","doi":"10.21037/aoe-21-57","DOIUrl":"https://doi.org/10.21037/aoe-21-57","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":"41972777","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}
Colm Mac Eochagain, K. Ronan, Calvin R Flynn, Z. Togher, J. Buchalter, M. Lowery
{"title":"Paraneoplastic syndromes in esophageal cancer—a narrative review","authors":"Colm Mac Eochagain, K. Ronan, Calvin R Flynn, Z. Togher, J. Buchalter, M. Lowery","doi":"10.21037/aoe-21-65","DOIUrl":"https://doi.org/10.21037/aoe-21-65","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":"43208407","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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