Pub Date : 2021-01-01DOI: 10.21037/AOE-2020-MTEC-06
D. Schizas, M. Vailas, M. Sotiropoulou, A. Kapelouzou, T. Liakakos
: Esophageal cancer (EC) is an aggressive type of malignancy which is nowadays responsible for 16,000 deaths solely in the USA region and 400,200 deaths in Western countries. Despite the fact that there have been significant improvements in multimodality therapies, operative and perioperative management, the overall 5-year survival rate ranges from 25–50%, and a significant proportion (30–50%) of patients will develop recurrence within months or few years after esophagectomy. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from EC. A literature search about surgical management of metachronous EC metastases was conducted and the results from the most relevant studies are presented. The types and locations of recurrence considerably differ among individual patients mainly categorized as locoregional at the site of anastomosis, lymphatic and hematogenic metastasis, or a combination of these. The standard treatment for EC patients experiencing recurrence is currently based on systemic chemotherapy and/or radiotherapy. Recent literature shows that in highly selected individuals, surgical resection of oligometastatic disease might lead to improved outcomes as far as survival rates are concerned over medical management alone. Nowadays, only few retrospective studies with small number of patients report the results of surgical treatment in oligometastatic disease. Thus, the low quality of existing scientific data is not yet possible to define the role of surgery as a part of multimodality treatment in patients with isolated distant recurrence in solid organs. However, a well-selected group of patients, especially those with a disease-free interval of more than 12 months with isolated one-field lymph node (LN) metastasis or solitary lesions in organs, might benefit from surgical management. hepatic and pulmonary resections in patients with liver and lung recurrences after resection of esophageal carcinoma, reporting a median overall survival of 13 months in 5 surgically treated patients with liver metastases.
{"title":"Surgery for metachronic metastasized esophageal cancer","authors":"D. Schizas, M. Vailas, M. Sotiropoulou, A. Kapelouzou, T. Liakakos","doi":"10.21037/AOE-2020-MTEC-06","DOIUrl":"https://doi.org/10.21037/AOE-2020-MTEC-06","url":null,"abstract":": Esophageal cancer (EC) is an aggressive type of malignancy which is nowadays responsible for 16,000 deaths solely in the USA region and 400,200 deaths in Western countries. Despite the fact that there have been significant improvements in multimodality therapies, operative and perioperative management, the overall 5-year survival rate ranges from 25–50%, and a significant proportion (30–50%) of patients will develop recurrence within months or few years after esophagectomy. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from EC. A literature search about surgical management of metachronous EC metastases was conducted and the results from the most relevant studies are presented. The types and locations of recurrence considerably differ among individual patients mainly categorized as locoregional at the site of anastomosis, lymphatic and hematogenic metastasis, or a combination of these. The standard treatment for EC patients experiencing recurrence is currently based on systemic chemotherapy and/or radiotherapy. Recent literature shows that in highly selected individuals, surgical resection of oligometastatic disease might lead to improved outcomes as far as survival rates are concerned over medical management alone. Nowadays, only few retrospective studies with small number of patients report the results of surgical treatment in oligometastatic disease. Thus, the low quality of existing scientific data is not yet possible to define the role of surgery as a part of multimodality treatment in patients with isolated distant recurrence in solid organs. However, a well-selected group of patients, especially those with a disease-free interval of more than 12 months with isolated one-field lymph node (LN) metastasis or solitary lesions in organs, might benefit from surgical management. hepatic and pulmonary resections in patients with liver and lung recurrences after resection of esophageal carcinoma, reporting a median overall survival of 13 months in 5 surgically treated patients with liver metastases.","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":"44548165","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}
Gastroesophageal reflux disease (GERD), is one of the most common gastrointestinal diseases treated by physicians, with most patients being successfully managed medically. Patients with refractory or persistent disease may be treated using minimally invasive surgical techniques. Patients may also elect for surgical treatment of GERD to avoid the potentially deleterious effects of long term antisecretory [proton pump inhibitor (PPI)] use. Preoperative workup is critical to establish the presence of GERD, to rule out concomitant or alternative pathology, and to document the presence or absence of coexisting esophageal motility disorders. When the technical tenants are respected, laparoscopic fundoplication is a safe and effective treatment of GERD. The general principles involve adequate mobilization of the gastroesophageal junction and gastric fundus, high mediastinal dissection, and demonstration of adequate intraabdominal esophageal length. This is followed by secure closure of the diaphragmatic crura, as well as creation of a fundoplication to reinforce the typically hypotonic lower esophageal sphincter. The type of fundoplication used is typically influenced by preoperative manometry, presence of dysphagia, and patient age. Long term symptomatic relief, without the need for antisecretory medications, is achievable for the majority of properly selected patients. Postoperative morbidity and mortality are uncommon following laparoscopic treatment of GERD. The following manuscript describes our method for performance of both laparoscopic complete and partial fundoplication.
{"title":"Minimally invasive fundoplication for gastroesophageal reflux disease","authors":"J. Lipman, T. Farrell","doi":"10.21037/AOE-20-100","DOIUrl":"https://doi.org/10.21037/AOE-20-100","url":null,"abstract":"Gastroesophageal reflux disease (GERD), is one of the most common gastrointestinal diseases treated by physicians, with most patients being successfully managed medically. Patients with refractory or persistent disease may be treated using minimally invasive surgical techniques. Patients may also elect for surgical treatment of GERD to avoid the potentially deleterious effects of long term antisecretory [proton pump inhibitor (PPI)] use. Preoperative workup is critical to establish the presence of GERD, to rule out concomitant or alternative pathology, and to document the presence or absence of coexisting esophageal motility disorders. When the technical tenants are respected, laparoscopic fundoplication is a safe and effective treatment of GERD. The general principles involve adequate mobilization of the gastroesophageal junction and gastric fundus, high mediastinal dissection, and demonstration of adequate intraabdominal esophageal length. This is followed by secure closure of the diaphragmatic crura, as well as creation of a fundoplication to reinforce the typically hypotonic lower esophageal sphincter. The type of fundoplication used is typically influenced by preoperative manometry, presence of dysphagia, and patient age. Long term symptomatic relief, without the need for antisecretory medications, is achievable for the majority of properly selected patients. Postoperative morbidity and mortality are uncommon following laparoscopic treatment of GERD. The following manuscript describes our method for performance of both laparoscopic complete and partial fundoplication.","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":"44704367","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}
Y. Alwatari, Dawit Ayalew, Athanasios E Sevdalis, Daniel Scheese, Vignesh Vudatha, W. Julliard, Rachit D Shah
Virginia Commonwealth University, Department of Surgery, Richmond, VA, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rachit D. Shah, MD. 1200 E Marshall St, Richmond, VA 23298. Email: rachit.shah@vcuhealth.org.
弗吉尼亚联邦大学，外科学系，Richmond, VA, USA贡献:(I)构思与设计:所有作者;行政支助:无;(三)提供研究材料或患者:无;(四)数据收集和汇编:所有作者;(五)数据分析和解释:无;(六)稿件撰写:全体作者;(七)稿件最终审定:全体作者。收信人:Rachit D. Shah, MD. 1200 E Marshall St, Richmond, VA 23298。电子邮件:rachit.shah@vcuhealth.org。
{"title":"Endoscopic resection techniques of benign esophageal tumors: literature review","authors":"Y. Alwatari, Dawit Ayalew, Athanasios E Sevdalis, Daniel Scheese, Vignesh Vudatha, W. Julliard, Rachit D Shah","doi":"10.21037/aoe-21-32","DOIUrl":"https://doi.org/10.21037/aoe-21-32","url":null,"abstract":"Virginia Commonwealth University, Department of Surgery, Richmond, VA, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rachit D. Shah, MD. 1200 E Marshall St, Richmond, VA 23298. Email: rachit.shah@vcuhealth.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":"45697216","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 : 2020-12-22DOI: 10.21037/AOE-2020-ETBE-02
T. Jaswani, Ashton Ellison, V. Konda
: Persistent injury from reflux to the distal esophagus is a known cause of Barrett’s esophagus (BE). Gastric acid can cause inflammation of the distal esophagus through inflammatory mediators such as cyclo-oxygenase-2, c-myc and mitogen-activated protein kinase signaling. Bile acid exposure to the esophageal mucosa can also exert damage by becoming non- ionized at acidic pH, entering cells and exerting mucosal injury through inflammation cytotoxic pathways. Bile acids also upregulate proto-oncogenes and c-myc. Inadequate acid suppression defined by impedance-pH monitoring is a modifiable risk factor and if left uncontrolled, will increase the risk of recurrence of intestinal metaplasia (IM). It has been shown that a rigorous acid control protocol in combination with endoscopic eradication therapy (EET) can reduce the recurrence of IM. We suggest the following medical treatment regimen for patients undergoing EET: to continue twice daily proton pump inhibitor (PPI), take liquid preparation sucralfate, a GI lidocaine cocktail mixture preparation for topical use as needed with meals and snacks, and a liquid diet for 1–2 days followed by a soft diet for up to a week after EET. Analgesia may be provided with acetaminophen and/or other non NSAIDS products if needed. Diet and lifestyle modifications should also be discussed alongside these recommendations. Both before and after EET, we recommend antireflux protocols including twice daily PPI and optimization of diet, lifestyle and adjunctive medications. By combining successful eradication of Barrett’s with a vigilant surveillance monitoring and optimal antireflux control, this can ultimately lead to improved patient outcomes and decrease recurrence of dysplasia and IM.
{"title":"Medical management of acid/bile reflux before, during and after endoscopic therapy for Barrett’s esophagus: a narrative review","authors":"T. Jaswani, Ashton Ellison, V. Konda","doi":"10.21037/AOE-2020-ETBE-02","DOIUrl":"https://doi.org/10.21037/AOE-2020-ETBE-02","url":null,"abstract":": Persistent injury from reflux to the distal esophagus is a known cause of Barrett’s esophagus (BE). Gastric acid can cause inflammation of the distal esophagus through inflammatory mediators such as cyclo-oxygenase-2, c-myc and mitogen-activated protein kinase signaling. Bile acid exposure to the esophageal mucosa can also exert damage by becoming non- ionized at acidic pH, entering cells and exerting mucosal injury through inflammation cytotoxic pathways. Bile acids also upregulate proto-oncogenes and c-myc. Inadequate acid suppression defined by impedance-pH monitoring is a modifiable risk factor and if left uncontrolled, will increase the risk of recurrence of intestinal metaplasia (IM). It has been shown that a rigorous acid control protocol in combination with endoscopic eradication therapy (EET) can reduce the recurrence of IM. We suggest the following medical treatment regimen for patients undergoing EET: to continue twice daily proton pump inhibitor (PPI), take liquid preparation sucralfate, a GI lidocaine cocktail mixture preparation for topical use as needed with meals and snacks, and a liquid diet for 1–2 days followed by a soft diet for up to a week after EET. Analgesia may be provided with acetaminophen and/or other non NSAIDS products if needed. Diet and lifestyle modifications should also be discussed alongside these recommendations. Both before and after EET, we recommend antireflux protocols including twice daily PPI and optimization of diet, lifestyle and adjunctive medications. By combining successful eradication of Barrett’s with a vigilant surveillance monitoring and optimal antireflux control, this can ultimately lead to improved patient outcomes and decrease recurrence of dysplasia and IM.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47141823","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 : 2020-12-10DOI: 10.21037/AOE-2020-ETBE-03
G. Pellegatta, A. D. Buono, A. Repici
: In the last decade, the management of Barrett’s esophagus (BE) has been broadly updated. Among the endoscopic ablative techniques, radiofrequency ablation (RFA) is highly effective and currently represents the standard of care for the eradication of BE after endoscopic resection of visible dysplastic lesions. Newly, some thermal and non-thermal endoscopic modalities have been investigated for treating BE, also as first-line in case of dysplasia. Data on the safety and efficacy of cryotherapy, hybrid argon plasma coagulation (APC) and EndoRotor resection have been recently reported in the literature. We aimed to review current evidence on novel endoscopic technologies emerging with the indication of treating BE, and to discuss their limitations, advantages and potential implementation in routine clinical practice as well as in clinical trials. A PubMed search was conducted up to August 2020 to identify relevant studies. Efficacy rates, in terms of dysplasia and metaplasia eradication, assessed for the emerging thermal and non-thermal endoscopic modalities are promising and similar to RFA. According to the present data, post-treatment stricture occurrence appears to be low especially after Hybrid-APC and EndoRotor. The current evidence on novel endoscopic techniques needs further endorsement by randomized clinical trials and meta-analysis. The comparison of these modalities to the traditional care by the ongoing clinical trials, particularly in naïve patients is highly warranted. 10 dysplasia, and survival in EAC is stage-dependent. Patients with non-dysplastic (ND) BE or low-grade dysplasia (LGD)
{"title":"Novel endoscopic therapies in Barrett’s esophagus: narrative review","authors":"G. Pellegatta, A. D. Buono, A. Repici","doi":"10.21037/AOE-2020-ETBE-03","DOIUrl":"https://doi.org/10.21037/AOE-2020-ETBE-03","url":null,"abstract":": In the last decade, the management of Barrett’s esophagus (BE) has been broadly updated. Among the endoscopic ablative techniques, radiofrequency ablation (RFA) is highly effective and currently represents the standard of care for the eradication of BE after endoscopic resection of visible dysplastic lesions. Newly, some thermal and non-thermal endoscopic modalities have been investigated for treating BE, also as first-line in case of dysplasia. Data on the safety and efficacy of cryotherapy, hybrid argon plasma coagulation (APC) and EndoRotor resection have been recently reported in the literature. We aimed to review current evidence on novel endoscopic technologies emerging with the indication of treating BE, and to discuss their limitations, advantages and potential implementation in routine clinical practice as well as in clinical trials. A PubMed search was conducted up to August 2020 to identify relevant studies. Efficacy rates, in terms of dysplasia and metaplasia eradication, assessed for the emerging thermal and non-thermal endoscopic modalities are promising and similar to RFA. According to the present data, post-treatment stricture occurrence appears to be low especially after Hybrid-APC and EndoRotor. The current evidence on novel endoscopic techniques needs further endorsement by randomized clinical trials and meta-analysis. The comparison of these modalities to the traditional care by the ongoing clinical trials, particularly in naïve patients is highly warranted. 10 dysplasia, and survival in EAC is stage-dependent. Patients with non-dysplastic (ND) BE or low-grade dysplasia (LGD)","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49136812","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 : 2020-12-02DOI: 10.21037/AOE-2019-MIE-08
Sarah Yousef, J. Luketich, I. Sarkaria
From the time of the first transthoracic esophagectomy to the present day, techniques for esophageal resection have evolved considerably. While open surgical techniques are still often employed, minimally invasive esophagectomy (MIE) has seen a tremendous rise in adoption in many centers worldwide and has in fact surpassed open esophagectomy. Robotic assisted minimally invasive esophagectomy (RAMIE) continues to increase steadily in recent years as well. Along with improved care algorithms including neoadjuvant and adjuvant treatments, minimally invasive approaches to esophageal resection have also contributed to a contemporaneous decrease in perioperative morbidity and mortality, as well as improvements in overall survival in esophageal cancer. Regardless of techniques or technologies employed, a continued reduction in complications such as anastomotic leak rate and pulmonary complications will be imperative in order to truly advance the field of esophageal resection. Importantly, endoscopic therapies such as endoscopic mucosal and submucosal resections (EMR/ESR) have garnered a substantial role in the treatment of early stage esophageal cancer. Novel robotic endoscopic platforms are in early development as well. The future of esophagectomy will no doubt continue to involve applications of new technology, including robotics and other novel developments.
{"title":"Future directions—minimally invasive approaches to esophageal resection: a narrative review","authors":"Sarah Yousef, J. Luketich, I. Sarkaria","doi":"10.21037/AOE-2019-MIE-08","DOIUrl":"https://doi.org/10.21037/AOE-2019-MIE-08","url":null,"abstract":"From the time of the first transthoracic esophagectomy to the present day, techniques for esophageal resection have evolved considerably. While open surgical techniques are still often employed, minimally invasive esophagectomy (MIE) has seen a tremendous rise in adoption in many centers worldwide and has in fact surpassed open esophagectomy. Robotic assisted minimally invasive esophagectomy (RAMIE) continues to increase steadily in recent years as well. Along with improved care algorithms including neoadjuvant and adjuvant treatments, minimally invasive approaches to esophageal resection have also contributed to a contemporaneous decrease in perioperative morbidity and mortality, as well as improvements in overall survival in esophageal cancer. Regardless of techniques or technologies employed, a continued reduction in complications such as anastomotic leak rate and pulmonary complications will be imperative in order to truly advance the field of esophageal resection. Importantly, endoscopic therapies such as endoscopic mucosal and submucosal resections (EMR/ESR) have garnered a substantial role in the treatment of early stage esophageal cancer. Novel robotic endoscopic platforms are in early development as well. The future of esophagectomy will no doubt continue to involve applications of new technology, including robotics and other novel developments.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42182783","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 : 2020-11-23DOI: 10.21037/AOE-2020-ETBE-01
Nour Hamade, Prateek Sharma
: Endoscopic therapy has largely replaced esophagectomy in the management of neoplastic lesions [high grade dysplasia (HGD) and early cancer] in patients with Barrett’s esophagus (BE). This change has improved the cost of treatment and decreased patient’s morbidity while maintaining comparable efficacy to surgery. A multitude of endoscopic techniques (resective and ablative) exist to completely eradicate the Barrett’s segment. Resective modalities such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are mostly used for visible or nodular Barrett’s lesions. Ablative modalities, such as radiofrequency ablation (RFA), cryoablation, and argon plasma coagulation (APC), are used to treat flat Barrett’s lesions. These resective and ablative modalities can be used alone or in combination to yield high rates of eradication. While more head to head trials are still needed to compare current modalities, the choice of technique can depend on several factors including the lesion morphology, Barrett’s segment length, the circumferential BE extent, side effect profile of treatment, availability of tools, as well as the physician’s expertise. In this review, we discuss when BE lesions can and should be treated endoscopically, provide an overview and comparison of the available endoscopic treatment modalities, updated research on upcoming technologies, and how these therapies can be positioned to treat BE in different clinical settings.
{"title":"A narrative review of endoscopic therapies in Barrett’s esophagus","authors":"Nour Hamade, Prateek Sharma","doi":"10.21037/AOE-2020-ETBE-01","DOIUrl":"https://doi.org/10.21037/AOE-2020-ETBE-01","url":null,"abstract":": Endoscopic therapy has largely replaced esophagectomy in the management of neoplastic lesions [high grade dysplasia (HGD) and early cancer] in patients with Barrett’s esophagus (BE). This change has improved the cost of treatment and decreased patient’s morbidity while maintaining comparable efficacy to surgery. A multitude of endoscopic techniques (resective and ablative) exist to completely eradicate the Barrett’s segment. Resective modalities such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are mostly used for visible or nodular Barrett’s lesions. Ablative modalities, such as radiofrequency ablation (RFA), cryoablation, and argon plasma coagulation (APC), are used to treat flat Barrett’s lesions. These resective and ablative modalities can be used alone or in combination to yield high rates of eradication. While more head to head trials are still needed to compare current modalities, the choice of technique can depend on several factors including the lesion morphology, Barrett’s segment length, the circumferential BE extent, side effect profile of treatment, availability of tools, as well as the physician’s expertise. In this review, we discuss when BE lesions can and should be treated endoscopically, provide an overview and comparison of the available endoscopic treatment modalities, updated research on upcoming technologies, and how these therapies can be positioned to treat BE in different clinical settings.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47767479","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}
: A 71-year-old male patient presented with recurrent acute dysphagia in 2017 on a background of previous episodes of upper esophageal food bolus obstruction and mild gastro-esophageal reflux disease several years ago. He was diagnosed with acute erosive esophagitis from candidiasis and chronic gastritis with intestinal metaplasia. These were treated with anti-fungal therapy and a proton pump inhibitor. A year later, he had recurrent dysphagia and found to have upper esophageal stricture and diffuse esophagitis with ulceration and hyperkeratosis. The same treatments were given but his problems recurred again another year later. Recurrent candidiasis was confirmed on esophageal biopsy and fungal culture. He was treated with a third course of anti-fungal therapy with good resolution of dysphagia symptom, esophagitis, and stricture, both clinically and endoscopically. Intramural pseudodiverticulosis of the upper esophagus was also evident during endoscopy and barium swallow study. Hyperkeratosis was persistent. He is planned for surveillance endoscopy for persistent esophageal hyperkeratosis and chronic gastritis with intestinal metaplasia. Ulceration, stricture, intramural pseudodiverticulosis and hyperkeratosis are the less common complications of esophageal candidiasis that we have seen all occurring on this patient. These may be further complicated by perforation or fistula formation from the inflammation and strictures, and mitotic lesion from hyperkeratosis. In conclusion, we should develop a higher level of clinical suspicion for esophageal candidiasis and recognize possible complications that may arise in severe, chronic or recurrent disease, in patients with recurrent esophageal symptoms, in order to treat them effectively.
{"title":"Recurrent esophageal candidiasis: a case report of different complications","authors":"S. Ching, T. Lim, Y. A. Ng","doi":"10.21037/AOE-20-29","DOIUrl":"https://doi.org/10.21037/AOE-20-29","url":null,"abstract":": A 71-year-old male patient presented with recurrent acute dysphagia in 2017 on a background of previous episodes of upper esophageal food bolus obstruction and mild gastro-esophageal reflux disease several years ago. He was diagnosed with acute erosive esophagitis from candidiasis and chronic gastritis with intestinal metaplasia. These were treated with anti-fungal therapy and a proton pump inhibitor. A year later, he had recurrent dysphagia and found to have upper esophageal stricture and diffuse esophagitis with ulceration and hyperkeratosis. The same treatments were given but his problems recurred again another year later. Recurrent candidiasis was confirmed on esophageal biopsy and fungal culture. He was treated with a third course of anti-fungal therapy with good resolution of dysphagia symptom, esophagitis, and stricture, both clinically and endoscopically. Intramural pseudodiverticulosis of the upper esophagus was also evident during endoscopy and barium swallow study. Hyperkeratosis was persistent. He is planned for surveillance endoscopy for persistent esophageal hyperkeratosis and chronic gastritis with intestinal metaplasia. Ulceration, stricture, intramural pseudodiverticulosis and hyperkeratosis are the less common complications of esophageal candidiasis that we have seen all occurring on this patient. These may be further complicated by perforation or fistula formation from the inflammation and strictures, and mitotic lesion from hyperkeratosis. In conclusion, we should develop a higher level of clinical suspicion for esophageal candidiasis and recognize possible complications that may arise in severe, chronic or recurrent disease, in patients with recurrent esophageal symptoms, in order to treat them effectively.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46240846","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 : 2020-10-26DOI: 10.21037/AOE-2019-MIE-07
R. Carr, D. Molena
Esophagectomy is one of the most technically challenging and potentially morbid procedures in thoracic surgery. Goals of esophagectomy include resection of the diseased esophagus with negative margins, an adequate lymphadenectomy, and restoration of gastrointestinal continuity. Traditionally, this required both a thoracotomy and laparotomy incision, which contributed significantly to the high rates of morbidity and mortality associated with this procedure. Esophageal surgery has since evolved considerably. Advances in minimally invasive techniques have improved surgical morbidity to the patient, while providing oncologic benefit that is equal or superior to open approaches. Despite these improvements, technical complications and their consequences persist. Anastomotic complications remain a significant cause of postoperative morbidity and mortality. Clinically, these complications are often devastating and can result in substantial reductions in postoperative quality of life and survival. For this reason, construction of the anastomosis is often considered the most critical step during an esophagectomy. Additionally, with the rise of minimally invasive esophagectomy, techniques for anastomotic construction have had to evolve in concert. As a result, the optimal technique and location for anastomotic creation is frequently debated. Despite extensive research debating the superior esophageal reconstruction method, there is no agreed upon operative standard. This review aims to highlight current methods and provide a critical review of current research.
{"title":"Minimally invasive esophagectomy: anastomotic techniques","authors":"R. Carr, D. Molena","doi":"10.21037/AOE-2019-MIE-07","DOIUrl":"https://doi.org/10.21037/AOE-2019-MIE-07","url":null,"abstract":"Esophagectomy is one of the most technically challenging and potentially morbid procedures in thoracic surgery. Goals of esophagectomy include resection of the diseased esophagus with negative margins, an adequate lymphadenectomy, and restoration of gastrointestinal continuity. Traditionally, this required both a thoracotomy and laparotomy incision, which contributed significantly to the high rates of morbidity and mortality associated with this procedure. Esophageal surgery has since evolved considerably. Advances in minimally invasive techniques have improved surgical morbidity to the patient, while providing oncologic benefit that is equal or superior to open approaches. Despite these improvements, technical complications and their consequences persist. Anastomotic complications remain a significant cause of postoperative morbidity and mortality. Clinically, these complications are often devastating and can result in substantial reductions in postoperative quality of life and survival. For this reason, construction of the anastomosis is often considered the most critical step during an esophagectomy. Additionally, with the rise of minimally invasive esophagectomy, techniques for anastomotic construction have had to evolve in concert. As a result, the optimal technique and location for anastomotic creation is frequently debated. Despite extensive research debating the superior esophageal reconstruction method, there is no agreed upon operative standard. This review aims to highlight current methods and provide a critical review of current research.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49047656","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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