: The Ivor Lewis MIE has been growing in popularity globally ever since it was made popular among the Western population by J. D. Luketich at the University of Pittsburgh Medical Center (UPMC). Most patients in the West present with distal esophageal or esophago-gastric junction cancers, which favour the Ivor Lewis MIE, and an intrathoracic anastomosis as the operation of choice. However, the debate continues over which type of esophago-gastric anastomosis should be performed. The end-to-side stapled intrathoracic esophago-gastric anastomosis with a 28 or 29 mm circular stapler, and covering the anastomosis with an omental flap, is a well-established standardised technique at the UPMC and Norwich. In experienced hands, this technique is easy to execute once the anvil is inserted into the esophagus and the two purse-string sutures are tied. It has a low leak rate (<5%) when executed correctly. In the rare occurrence of a leak, the exact site of the leak can be visualised with a computerised tomography scan, since the titanium staples are easily identified radiologically. As a result, the defect at the circular anastomosis is easily located endoscopically. In addition, the leak is often small. Altogether, these factors favour the use of an EndoVac to treat the leak from a circular stapler. Hence, the authors advocate doing the circular stapled end-to-side esophago-gastric anastomosis, which is covered with an omental patch under a pleural tent.
：自从匹兹堡大学医学中心的J.D.Luketich在西方人群中流行以来，Ivor Lewis MIE在全球范围内越来越受欢迎。西方的大多数患者都患有食管远端或食管-胃交界处癌症，这有利于Ivor Lewis MIE，并将胸内吻合作为首选手术。然而，关于应该进行哪种类型的食管胃吻合的争论仍在继续。在UPMC和Norwich，用28或29毫米圆形吻合器端侧缝合胸内食管胃吻合，并用网膜瓣覆盖吻合，是一种公认的标准化技术。对于经验丰富的人来说，一旦将铁砧插入食道并绑上两条荷包线，这项技术就很容易实施。正确执行时，泄漏率较低（<5%）。在罕见的泄漏情况下，可以通过计算机断层扫描来显示泄漏的确切位置，因为钛钉很容易通过放射学识别。因此，环形吻合处的缺陷很容易在内镜下定位。此外，泄漏通常很小。总之，这些因素有利于使用EndoVac治疗圆形缝合器的泄漏。因此，作者主张进行环形吻合食管胃端侧吻合术，该吻合术在胸膜帐篷下覆盖网膜贴片。
{"title":"End to side anastomosis with a circular stapler for minimally invasive Ivor Lewis esophagectomy—how I do it","authors":"E. Cheong, J. Luketich","doi":"10.21037/aoe-21-35","DOIUrl":"https://doi.org/10.21037/aoe-21-35","url":null,"abstract":": The Ivor Lewis MIE has been growing in popularity globally ever since it was made popular among the Western population by J. D. Luketich at the University of Pittsburgh Medical Center (UPMC). Most patients in the West present with distal esophageal or esophago-gastric junction cancers, which favour the Ivor Lewis MIE, and an intrathoracic anastomosis as the operation of choice. However, the debate continues over which type of esophago-gastric anastomosis should be performed. The end-to-side stapled intrathoracic esophago-gastric anastomosis with a 28 or 29 mm circular stapler, and covering the anastomosis with an omental flap, is a well-established standardised technique at the UPMC and Norwich. In experienced hands, this technique is easy to execute once the anvil is inserted into the esophagus and the two purse-string sutures are tied. It has a low leak rate (<5%) when executed correctly. In the rare occurrence of a leak, the exact site of the leak can be visualised with a computerised tomography scan, since the titanium staples are easily identified radiologically. As a result, the defect at the circular anastomosis is easily located endoscopically. In addition, the leak is often small. Altogether, these factors favour the use of an EndoVac to treat the leak from a circular stapler. Hence, the authors advocate doing the circular stapled end-to-side esophago-gastric anastomosis, which is covered with an omental patch under a pleural tent.","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":"49568506","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}
Ethan Y. Song, S. Naffouje, Sabrina Saeed, A. Glaser, Miles E. Cameron, J. Fontaine, L. Peña, M. Friedman, R. Mehta, Sarah Hoffe, J. Frakes, J. Pimiento
Background: Young patients with esophageal cancer (EC) are believed to have more aggressive disease, thus thought to have worse survival. Herein, we aim to study the impact of younger age on the short- and long-term outcomes of esophagectomy for EC. Methods: Patients who underwent esophagectomy for EC at our institution between 1994–2019 were included. Age 50 was defined as the cutoff for “young” vs . “old”. Patients from each age group were propensity-score matched 1:1 to compare postoperative and survival outcomes. Results: Our database reported 1,031 patients, 112 of whom were in the ‘young’ group. For the unmatched analysis, young patients were more likely to have squamous cell carcinoma, higher rates of locally advanced disease, and subsequently higher rates of neoadjuvant chemotherapy (79.5% vs . 68.3%; P=0.047). After matching for pre-treatment clinical factors, young patients were less likely to have pulmonary or cardiac complications after surgery, and three times more likely to receive AC despite matching for stage and response to treatment (26.7% vs . 7.9%; P=0.002). Then, we matched patients including receipt of AC to study survival. In the second match, median recurrence-free survival (RFS) for young patients was 49.0±26.0 vs . old 27.0±5.4 months (P=0.215). Median overall survival (OS) for young was 73.0±28.9 vs . old 31.0±6.3 months (P=0.073). Conclusions: Young EC patients tend to present with more advanced disease. However, when matched for stage and response to therapies, young patients were three-times more likely to be offered AC. After adjusting for receipt of adjuvant therapy no difference was detected in RFS.
背景:年轻食管癌(EC)患者被认为具有更强的侵袭性，因此被认为生存率较差。在此，我们的目的是研究年轻对食管切除术治疗EC的短期和长期结果的影响。方法:纳入1994-2019年在我院接受食管切除术的EC患者。50岁被定义为“年轻”与“年轻”的分界线。“老”。每个年龄组的患者进行倾向评分1:1匹配，以比较术后和生存结果。结果:我们的数据库报告了1031例患者，其中112例属于“年轻”组。在非匹配分析中，年轻患者更容易患鳞状细胞癌，局部晚期疾病的发生率更高，随后新辅助化疗的发生率更高(79.5% vs . 79.5%)。68.3%;P = 0.047)。在匹配治疗前临床因素后，年轻患者术后发生肺部或心脏并发症的可能性较小，尽管分期和治疗反应匹配，但接受AC治疗的可能性是前者的三倍(26.7% vs。7.9%;P = 0.002)。然后，我们匹配包括接受AC的患者来研究生存率。在第二次配对中，年轻患者的中位无复发生存期(RFS)为49.0±26.0。年龄27.0±5.4个月(P=0.215)。年轻人的中位总生存期(OS)为73.0±28.9;老年31.0±6.3个月(P=0.073)。结论:年轻的EC患者往往表现为更晚期的疾病。然而，当分期和对治疗的反应相匹配时，年轻患者接受AC治疗的可能性增加了三倍。在调整接受辅助治疗后，RFS没有发现差异。
{"title":"Esophageal cancer in young patients: does age affect treatment course and outcomes?","authors":"Ethan Y. Song, S. Naffouje, Sabrina Saeed, A. Glaser, Miles E. Cameron, J. Fontaine, L. Peña, M. Friedman, R. Mehta, Sarah Hoffe, J. Frakes, J. Pimiento","doi":"10.21037/AOE-20-92","DOIUrl":"https://doi.org/10.21037/AOE-20-92","url":null,"abstract":"Background: Young patients with esophageal cancer (EC) are believed to have more aggressive disease, thus thought to have worse survival. Herein, we aim to study the impact of younger age on the short- and long-term outcomes of esophagectomy for EC. Methods: Patients who underwent esophagectomy for EC at our institution between 1994–2019 were included. Age 50 was defined as the cutoff for “young” vs . “old”. Patients from each age group were propensity-score matched 1:1 to compare postoperative and survival outcomes. Results: Our database reported 1,031 patients, 112 of whom were in the ‘young’ group. For the unmatched analysis, young patients were more likely to have squamous cell carcinoma, higher rates of locally advanced disease, and subsequently higher rates of neoadjuvant chemotherapy (79.5% vs . 68.3%; P=0.047). After matching for pre-treatment clinical factors, young patients were less likely to have pulmonary or cardiac complications after surgery, and three times more likely to receive AC despite matching for stage and response to treatment (26.7% vs . 7.9%; P=0.002). Then, we matched patients including receipt of AC to study survival. In the second match, median recurrence-free survival (RFS) for young patients was 49.0±26.0 vs . old 27.0±5.4 months (P=0.215). Median overall survival (OS) for young was 73.0±28.9 vs . old 31.0±6.3 months (P=0.073). Conclusions: Young EC patients tend to present with more advanced disease. However, when matched for stage and response to therapies, young patients were three-times more likely to be offered AC. After adjusting for receipt of adjuvant therapy no difference was detected in RFS.","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":"47195903","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}
: Computer-assisted diagnosis (CAD) using deep learning, based on convolutional neural networks (CNNs), is rapidly developing in modern society and clinical practice. In the medical field of endoscopy, a CAD system can be used in the detection and staging of superficial esophageal cancer. In the detection of superficial esophageal squamous cell carcinoma (ESCC), several studies were reported as using still images of conventional white-light endoscopy and narrow-band imaging (NBI). The sensitivity of CAD systems is over 90%, and in some reports, higher than that of expert endoscopists. In addition, there is a report using video for a validation set that showed good performance. In diagnosing invasion depth, there are reports using conventional white-light imaging, NBI, and magnifying endoscopy with NBI using still images; there are also reports of intrapapillary capillary loop pattern identification using still images. Using white-light endoscopy and NBI, CAD systems showed sensitivity of 84.1–95.4%, specificity of 73.3–79.2%, and accuracy of 80.9–92.9% for differentiating SM1 cancers from SM2 or SM3 cancers in pathology. Additional systems could accurately classify intrapapillary capillary loop patterns as normal or abnormal, with comparable performance to experienced endoscopists. As for esophageal adenocarcinoma (EAC) that arises in Barrett’s esophagus (BE), there are detection reports that show favorable performance. Furthermore, the CAD system from one report identified the location suitable for biopsy; this is helpful for endoscopists because of the difficulty in determining the location of early EAC in BE. Although these studies are still only at research level, excellent performance has been achieved for detecting and staging of superficial esophageal carcinoma by CAD systems. In the near future, CAD systems will support us in detecting and staging esophageal cancers in daily clinical practice, leading to a better prognosis. 9
{"title":"Development of artificial intelligence for the detection and staging of esophageal cancer","authors":"Y. Tokai, T. Yoshio, J. Fujisaki","doi":"10.21037/aoe-2020-33","DOIUrl":"https://doi.org/10.21037/aoe-2020-33","url":null,"abstract":": Computer-assisted diagnosis (CAD) using deep learning, based on convolutional neural networks (CNNs), is rapidly developing in modern society and clinical practice. In the medical field of endoscopy, a CAD system can be used in the detection and staging of superficial esophageal cancer. In the detection of superficial esophageal squamous cell carcinoma (ESCC), several studies were reported as using still images of conventional white-light endoscopy and narrow-band imaging (NBI). The sensitivity of CAD systems is over 90%, and in some reports, higher than that of expert endoscopists. In addition, there is a report using video for a validation set that showed good performance. In diagnosing invasion depth, there are reports using conventional white-light imaging, NBI, and magnifying endoscopy with NBI using still images; there are also reports of intrapapillary capillary loop pattern identification using still images. Using white-light endoscopy and NBI, CAD systems showed sensitivity of 84.1–95.4%, specificity of 73.3–79.2%, and accuracy of 80.9–92.9% for differentiating SM1 cancers from SM2 or SM3 cancers in pathology. Additional systems could accurately classify intrapapillary capillary loop patterns as normal or abnormal, with comparable performance to experienced endoscopists. As for esophageal adenocarcinoma (EAC) that arises in Barrett’s esophagus (BE), there are detection reports that show favorable performance. Furthermore, the CAD system from one report identified the location suitable for biopsy; this is helpful for endoscopists because of the difficulty in determining the location of early EAC in BE. Although these studies are still only at research level, excellent performance has been achieved for detecting and staging of superficial esophageal carcinoma by CAD systems. In the near future, CAD systems will support us in detecting and staging esophageal cancers in daily clinical practice, leading to a better prognosis. 9","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68296765","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 an intestinal-type metaplastic condition of the esophagus, which occurs in response to severe inflammation generally as result of chronic gastro-esophageal reflux. Over the last 5 decades, since the link between BE and esophageal adenocarcinoma (EAC) has been established, endoscopy has played a key role in the management of this condition, as a procedure initially to diagnose and monitor the precancerous disease and more recently also to deliver therapeutic interventions. The treatment algorithm for BE has seen dramatic changes in the last 10 years thanks to the better understanding of the natural history of dysplasia and early EAC and to the advent of effective endoscopic ablation techniques. Nevertheless, the incidence of EAC is increasing worldwide and many questions still remain to be addressed. There is growing need to combine technological advances with early diagnosis and targeted pharmacological treatments in order to refine management strategies. This would ideally entail early intervention on patients with a high probability to progress to cancer and minimally invasive treatment in patients with cancer at low metastatic risk. In this article we will discuss how improved understanding about the molecular make up of the disease and the emerging diagnostic and therapeutic technologies at the horizon can help reshape the endoscopic management of BE in the near future. 15
{"title":"The future of therapy of Barrett’s esophagus and related cancer: a narrative review","authors":"N. Pilonis, M. Pietro","doi":"10.21037/AOE-20-93","DOIUrl":"https://doi.org/10.21037/AOE-20-93","url":null,"abstract":": Barrett’s esophagus (BE) is an intestinal-type metaplastic condition of the esophagus, which occurs in response to severe inflammation generally as result of chronic gastro-esophageal reflux. Over the last 5 decades, since the link between BE and esophageal adenocarcinoma (EAC) has been established, endoscopy has played a key role in the management of this condition, as a procedure initially to diagnose and monitor the precancerous disease and more recently also to deliver therapeutic interventions. The treatment algorithm for BE has seen dramatic changes in the last 10 years thanks to the better understanding of the natural history of dysplasia and early EAC and to the advent of effective endoscopic ablation techniques. Nevertheless, the incidence of EAC is increasing worldwide and many questions still remain to be addressed. There is growing need to combine technological advances with early diagnosis and targeted pharmacological treatments in order to refine management strategies. This would ideally entail early intervention on patients with a high probability to progress to cancer and minimally invasive treatment in patients with cancer at low metastatic risk. In this article we will discuss how improved understanding about the molecular make up of the disease and the emerging diagnostic and therapeutic technologies at the horizon can help reshape the endoscopic management of BE in the near future. 15","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":"42703338","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}
: Pulmonary manifestations of the novel coronavirus, COVID-19, have been discussed heavily in the literature, however, there have been minimal reports regarding extra-pulmonary manifestations of the disease to date. In particular, there has been no literature to date discussing the pathophysiology or incidence of esophageal perforation in the COVID-19 patient. This case report describes a 65-year-old COVID-19 positive male presenting with a case of spontaneous esophageal perforation. The patient underwent esophagogastroduodenoscopy (EGD) with stent placement followed by thoracoscopic evacuation of gastric contents from the pleural spaces and mediastinal drainage. His clinical course was unique in that his esophageal perforation management was complicated by logistical and technical challenges due to COVID-19 infection. Several precautions were required before, during and after each test or intervention performed on the patient. This created a challenging set of circumstances which had not been dealt with in the past. Nevertheless, after a two-week hospital stay, the patient was discharged in stable condition with plans for outpatient follow-up and removal of stent. This case report provides an unusual presentation of esophageal perforation in a patient with concurrent COVID-19 infection while highlighting the special techniques required to diagnose and treat the patient. 5
{"title":"COVID-19 and spontaneous esophageal perforation: a case report","authors":"S. S. Rao, Katy Marino, M. Steliga, J. Muesse","doi":"10.21037/aoe-20-60","DOIUrl":"https://doi.org/10.21037/aoe-20-60","url":null,"abstract":": Pulmonary manifestations of the novel coronavirus, COVID-19, have been discussed heavily in the literature, however, there have been minimal reports regarding extra-pulmonary manifestations of the disease to date. In particular, there has been no literature to date discussing the pathophysiology or incidence of esophageal perforation in the COVID-19 patient. This case report describes a 65-year-old COVID-19 positive male presenting with a case of spontaneous esophageal perforation. The patient underwent esophagogastroduodenoscopy (EGD) with stent placement followed by thoracoscopic evacuation of gastric contents from the pleural spaces and mediastinal drainage. His clinical course was unique in that his esophageal perforation management was complicated by logistical and technical challenges due to COVID-19 infection. Several precautions were required before, during and after each test or intervention performed on the patient. This created a challenging set of circumstances which had not been dealt with in the past. Nevertheless, after a two-week hospital stay, the patient was discharged in stable condition with plans for outpatient follow-up and removal of stent. This case report provides an unusual presentation of esophageal perforation in a patient with concurrent COVID-19 infection while highlighting the special techniques required to diagnose and treat the patient. 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":"47856126","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: To review the current state of functional esophageal evaluation in the gastrointestinal (GI) motility laboratory, highlighting updates in established modalities along with new technologies. Background: The GI motility laboratory has been transformed the decade, modernizing its approaches for the evaluation of esophageal motility disorders and gastroesophageal reflux disease (GERD). Conclusions: The esophageal motility evaluation often starts with high-resolution esophageal manometry, now with enhanced protocols using provocative maneuvers to increase detection and understanding of esophageal motility disorders. Esophageal manometry now involves recording esophageal motility both in the supine and upright positions as well as in response to multiple rapid swallows and rapid drinking challenge. Endoscopic functional luminal imaging probe (EndoFLIP) using impedance planimetry technology can assess the compliance of the lower esophageal sphincter (LES), as well as can be utilized for assessment of esophageal motility during endoscopy. Ambulatory esophageal pH monitoring studies remain the standard for the diagnosis of GERD. Multichannel intraluminal impedance-pH (MII-pH) has the advantage of measuring impedance to identify non-acidic reflux episodes—a particularly important feature in patients not responding to proton pump inhibitors (PPIs), those with atypical GERD symptoms, and in patients who cannot stop their PPIs for their evaluation. Novel metrics include mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index which help differentiate GERD, non-erosive reflux disease (NERD), and reflux hypersensitivity from functional heartburn and normal subjects. They also can help predict outcome and response to medical and procedural therapies. Wireless pH capsule monitoring involves endoscopic attachment of a radiotelemetry capsule in the distal esophagus providing multi-day recording of esophageal pH. It is more tolerable than MII-pH allowing patients to resume their daily activities that might precipitate reflux. The GI motility laboratory has modernized approaches for the evaluation of esophageal function. for impedance For normal subjects PPI the upper of AET is 2.5% and normal subjects taking PPI BID, the upper limit of esophageal acid exposure to 1.3%.
{"title":"Modern evaluation of esophageal function in the gastrointestinal motility laboratory: a narrative review","authors":"M. Malamood, D. Shahsavari, H. Parkman","doi":"10.21037/aoe-21-36","DOIUrl":"https://doi.org/10.21037/aoe-21-36","url":null,"abstract":"Objective: To review the current state of functional esophageal evaluation in the gastrointestinal (GI) motility laboratory, highlighting updates in established modalities along with new technologies. Background: The GI motility laboratory has been transformed the decade, modernizing its approaches for the evaluation of esophageal motility disorders and gastroesophageal reflux disease (GERD). Conclusions: The esophageal motility evaluation often starts with high-resolution esophageal manometry, now with enhanced protocols using provocative maneuvers to increase detection and understanding of esophageal motility disorders. Esophageal manometry now involves recording esophageal motility both in the supine and upright positions as well as in response to multiple rapid swallows and rapid drinking challenge. Endoscopic functional luminal imaging probe (EndoFLIP) using impedance planimetry technology can assess the compliance of the lower esophageal sphincter (LES), as well as can be utilized for assessment of esophageal motility during endoscopy. Ambulatory esophageal pH monitoring studies remain the standard for the diagnosis of GERD. Multichannel intraluminal impedance-pH (MII-pH) has the advantage of measuring impedance to identify non-acidic reflux episodes—a particularly important feature in patients not responding to proton pump inhibitors (PPIs), those with atypical GERD symptoms, and in patients who cannot stop their PPIs for their evaluation. Novel metrics include mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index which help differentiate GERD, non-erosive reflux disease (NERD), and reflux hypersensitivity from functional heartburn and normal subjects. They also can help predict outcome and response to medical and procedural therapies. Wireless pH capsule monitoring involves endoscopic attachment of a radiotelemetry capsule in the distal esophagus providing multi-day recording of esophageal pH. It is more tolerable than MII-pH allowing patients to resume their daily activities that might precipitate reflux. The GI motility laboratory has modernized approaches for the evaluation of esophageal function. for impedance For normal subjects PPI the upper of AET is 2.5% and normal subjects taking PPI BID, the upper limit of esophageal acid exposure to 1.3%.","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":"49583282","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}
E. M. D. Groot, Feike Kingma, L. Goense, S. Horst, J. W. Berg, R. Hillegersberg, J. Ruurda
Background: In two-stage minimally invasive esophagectomy (MIE), most surgeons use a stapling device to avoid the challenges of thoracoscopic suturing in the upper mediastinum. However, in robot-assisted minimally invasive esophagectomy (RAMIE), the surgeon benefits from increased dexterity that facilitates the construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of a refined technique for the robot-assisted hand-sewn intrathoracic anastomosis in RAMIE, which was introduced in 2016 in our center. Methods: Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis between 1 November 2019 and 1 November 2020 were included in the current retrospective study. During this time frame, the technique was uniform and no more refinements were made. Data were extracted from a prospectively maintained database. Main elements of the anastomotic technique included supportive stay-stitches to keep esophageal mucosa to the muscular wall, manual barbed suturing of the posterior and anterior wall, placement of tension releasing stitches and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage and secondary outcomes included the duration of anastomosis construction. Results: During the inclusion period, 22 patients were included in the study. Anastomotic leakage occurred in 3 patients (14%), which involved a grade I leak in 2 patients (9%) and grade 3 leakage in 1 patient (5%). The total duration of anastomosis construction was 37 minutes (range, 25–48 minutes). Conclusions: This study shows that a robot-assisted hand-sewn intrathoracic anastomosis can yield good outcomes in RAMIE.
{"title":"Robot-assisted hand-sewn intrathoracic anastomosis after esophagectomy","authors":"E. M. D. Groot, Feike Kingma, L. Goense, S. Horst, J. W. Berg, R. Hillegersberg, J. Ruurda","doi":"10.21037/AOE-20-98","DOIUrl":"https://doi.org/10.21037/AOE-20-98","url":null,"abstract":"Background: In two-stage minimally invasive esophagectomy (MIE), most surgeons use a stapling device to avoid the challenges of thoracoscopic suturing in the upper mediastinum. However, in robot-assisted minimally invasive esophagectomy (RAMIE), the surgeon benefits from increased dexterity that facilitates the construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of a refined technique for the robot-assisted hand-sewn intrathoracic anastomosis in RAMIE, which was introduced in 2016 in our center. Methods: Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis between 1 November 2019 and 1 November 2020 were included in the current retrospective study. During this time frame, the technique was uniform and no more refinements were made. Data were extracted from a prospectively maintained database. Main elements of the anastomotic technique included supportive stay-stitches to keep esophageal mucosa to the muscular wall, manual barbed suturing of the posterior and anterior wall, placement of tension releasing stitches and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage and secondary outcomes included the duration of anastomosis construction. Results: During the inclusion period, 22 patients were included in the study. Anastomotic leakage occurred in 3 patients (14%), which involved a grade I leak in 2 patients (9%) and grade 3 leakage in 1 patient (5%). The total duration of anastomosis construction was 37 minutes (range, 25–48 minutes). Conclusions: This study shows that a robot-assisted hand-sewn intrathoracic anastomosis can yield good outcomes in RAMIE.","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":"46890774","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-MEP-02
D. Nachira, V. Porziella
{"title":"Management of esophageal perforations and benign diseases","authors":"D. Nachira, V. Porziella","doi":"10.21037/AOE-2020-MEP-02","DOIUrl":"https://doi.org/10.21037/AOE-2020-MEP-02","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":"49522085","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-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}
{"title":"Understanding the challenge in esophageal anastomosis","authors":"A. Nieponice","doi":"10.21037/aoe-21-72","DOIUrl":"https://doi.org/10.21037/aoe-21-72","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":"45842800","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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