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Image Enhanced Endoscopy in Esophageal Squamous Cell Carcinoma 影像增强内镜在食管鳞状细胞癌中的应用
Pub Date : 2023-11-13 DOI: 10.1177/26345161231211752
Shaleen Vasavada, Sharmila Anandasabapathy
Esophageal Squamous Cell Carcinoma (ESCC) accounts for a significant portion of esophageal cancer cases worldwide, particularly in high-risk regions like China, Iran, and eastern Africa. It is often diagnosed at advanced stages, leading to poor prognosis and limited treatment options. Image-enhanced endoscopy enables precise visualization of abnormal mucosa, aiding in targeted biopsies for early detection of ESCC and reducing unnecessary sampling. Various techniques have emerged including lugol’s chromoendoscopy, narrow-band imaging, confocal laser endomicroscopy, and high-resolution microendoscopy. This article also discusses advancements in post-processing imaging technology and the novel role of Artificial Intelligence (AI) in improving diagnostic accuracy. While image enhanced endoscopy is promising, challenges such as training, standardization, and long-term validation remain. Implementing image enhanced endoscopy, combined with advancements in AI, has the potential to transform ESCC diagnosis and significantly improve patient outcomes, especially in high-risk populations.
食管鳞状细胞癌(ESCC)占全球食管癌病例的很大一部分,特别是在中国、伊朗和东非等高风险地区。它通常在晚期被诊断出来,导致预后不良和治疗选择有限。图像增强内窥镜能够精确显示异常粘膜,有助于早期发现ESCC的靶向活检,减少不必要的采样。各种技术已经出现,包括lugol色内窥镜、窄带成像、共聚焦激光内窥镜和高分辨率显微内窥镜。本文还讨论了后处理成像技术的进展以及人工智能(AI)在提高诊断准确性方面的新作用。虽然图像增强内窥镜很有前途,但训练、标准化和长期验证等挑战仍然存在。实施图像增强内窥镜检查,结合人工智能的进步,有可能改变ESCC的诊断,并显着改善患者的预后,特别是在高危人群中。
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引用次数: 0
Empiric Esophageal Dilation for the Treatment of Non-Obstructive Dysphagia 经验性食管扩张术治疗非阻塞性吞咽困难
Pub Date : 2023-11-09 DOI: 10.1177/26345161231211749
Katherine Macmillan, Yianni Protopapadakis, Gary A. Abrams, Madhusudhan Sunkavalli
Background: Non-obstructive dysphagia is a commonly encountered clinical problem. Methods: We retrospectively analyzed a single tertiary hospital system electronic database from January 2021 to October 2021 for patients undergoing EGD with dilation using ICD-10 codes 43248 and 42450. Results: Of the 411 patients meeting inclusion criteria, 75% of these patients had improvement with empiric dilation. The presence of a superficial mucosal tear post dilation was statistically significant. Conclusion: Empiric dilation is a useful tool for patients with non-obstructive dysphagia.
背景:非阻塞性吞咽困难是一个常见的临床问题。方法:我们回顾性分析了2021年1月至2021年10月单一三级医院系统电子数据库中使用ICD-10代码43248和42450进行扩张的EGD患者。结果:在符合纳入标准的411例患者中,75%的患者通过经验性扩张得到改善。扩张后浅表粘膜撕裂的存在具有统计学意义。结论:经验性扩张术是治疗非阻塞性吞咽困难的有效手段。
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引用次数: 0
Invited Commentary: Reflux Disease Questionnaire Scoring and Utilization: A Scoping Review 特邀评论:反流疾病问卷评分和使用:范围审查
Pub Date : 2023-11-06 DOI: 10.1177/26345161231211769
George Malcolm Taylor, Vic Velanovich
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引用次数: 0
The Impact of Gastroparesis on Medical Therapy for Gastroesophageal Reflux Disease (GERD) 胃轻瘫对胃食管反流病药物治疗的影响
Pub Date : 2023-11-06 DOI: 10.1177/26345161231211758
Alexander Reddy, C. Prakash Gyawali, Amit Patel
Symptoms suspicious for gastroesophageal reflux disease (GERD) represent frequent indications for medical presentation, as do symptoms potentially compatible with delayed gastric emptying. In this clinical setting, care must be taken to characterize patient symptoms accurately, and also appropriately evaluate for pathophysiologic processes including visceral hypersensitivity, rumination syndrome, supragastric belching, cannabinoid hyperemesis, and cyclic vomiting syndrome. While proton pump inhibitors (PPI) are the foundation of medical management of GERD, delayed gastric emptying is a downstream factor that can promote gastroesophageal reflux and warrants tailored clinical management. Specifically, patients with refractory symptoms in the setting of GERD and delayed gastric emptying may benefit from personalized adjunct medical therapy with prokinetics.
怀疑胃食管反流病(GERD)的症状是医学表现的常见指征,可能与胃排空延迟相容的症状也是如此。在这种临床环境中,必须注意准确地描述患者的症状,并适当地评估病理生理过程,包括内脏过敏、反刍综合征、胃上嗳气、大麻素剧吐和循环呕吐综合征。虽然质子泵抑制剂(PPI)是胃反流医学管理的基础,但胃排空延迟是促进胃食管反流的下游因素,需要有针对性的临床管理。具体来说,在胃反流和胃排空延迟的情况下,有难治性症状的患者可能受益于个性化的辅助药物治疗。
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引用次数: 0
Gastric Electrical Stimulation is an Effective Treatment Modality for Symptoms of GERD in Patients With Gastroparesis and VACTERL Association 胃电刺激是胃轻瘫患者胃反流症状的有效治疗方式
Pub Date : 2023-11-06 DOI: 10.1177/26345161231211017
Andrea Pagan-Bolivar, Prateek Mathur, Le Yu Naing, Abigail Stocker, Samuel Carson, Mary Fallat, Thomas L. Abell
Patients with VACTERL Association have multiple gastrointestinal comorbidities extending into adulthood. The term VACTERL stands for vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula (TEF) with or without esophageal atresia (EA), renal anomalies, and limb abnormalities. Symptoms of gastroesophageal reflux disease (GERD), such as heartburn and acid regurgitation, are common in this population, and patients with EA have a higher risk. Multiple therapies have been suggested to treat symptoms of GERD in patients with gastroparesis and VACTERL Association, including acid suppression therapy and treating the underlying gastroparesis. If left untreated, patients who had EA can experience severe complications, including erosive esophagitis, Barrett’s esophagus (BE), peptic strictures, esophageal cancer, and decrease in quality of life. We present 2 cases of patients with VACTERL Association with prior EA, gastroparesis and underlying symptoms of GERD that were successfully treated with gastric electrical stimulation (GES).
VACTERL关联患者有多种胃肠道合并症,可延伸至成年期。术语VACTERL代表椎体缺陷、肛门闭锁、心脏缺陷、伴有或不伴有食管闭锁(EA)的气管-食管瘘(TEF)、肾脏异常和肢体异常。胃食管反流病(GERD)的症状,如胃灼热和胃酸反流,在这一人群中很常见,EA患者的风险更高。对于胃轻瘫和VACTERL关联患者的GERD症状,建议采用多种治疗方法,包括抑酸治疗和治疗潜在的胃轻瘫。如果不及时治疗,患有EA的患者会出现严重的并发症,包括糜烂性食管炎、巴雷特食管(BE)、消化性狭窄、食管癌和生活质量下降。我们报告了2例与既往EA,胃轻瘫和胃反流症状相关的VACTERL患者,并成功地通过胃电刺激(GES)治疗。
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引用次数: 0
Presidential Address 2023: “Just by Showing Up” 2023年总统演讲:“只要出现”
Pub Date : 2023-11-06 DOI: 10.1177/26345161231211577
Reginald Bell
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引用次数: 0
Epidemiology of Esophageal Squamous Cell Carcinoma 食管鳞状细胞癌的流行病学研究
Pub Date : 2023-10-26 DOI: 10.1177/26345161231201961
Swathikan Chidambaram, Sheraz Rehan Markar
Esophageal squamous cell carcinoma (ESCC) is a leading cause of death worldwide, particularly prevalent in Southern and Eastern Africa, and central Asia. Initial studies identified various factors associated with an increased risk of ESCC, leading to subsequent research investigating the underlying biological mechanisms. This narrative review aims to summarize the role of risk factors in ESCC development and propose future research directions. A systematic literature search was conducted using EMBASE, MEDLINE/PubMed, and CENTRAL databases to identify relevant publications. Included studies updated the epidemiology of ESCC, including the incidence, prevalence and mortality and its variations globally. We reported on socio-demographic impact on these geographic variations. We, then, focused on identifying risk factors associated with ESCC. The identified risk factors were categorized into 5 subcategories: smoking, alcohol, dietary factors, environmental factors and infection. Each subcategory’s risk factors were summarized and explored, providing geographical links for these associations. The review emphasizes the current understanding of several risk factors for ESCC, and specifically makes geographical links, and potential explanations for their associations were explored. However, further research is essential to validate these findings and gain insights into their impact on tumor biology.
食管鳞状细胞癌(ESCC)是世界范围内的主要死亡原因,在非洲南部和东部以及中亚尤为普遍。最初的研究确定了与ESCC风险增加相关的各种因素,导致后续研究调查潜在的生物学机制。本文旨在总结危险因素在ESCC发展中的作用,并提出未来的研究方向。使用EMBASE、MEDLINE/PubMed和CENTRAL数据库进行系统文献检索,以确定相关出版物。纳入的研究更新了ESCC的流行病学,包括全球发病率、流行率和死亡率及其变化。我们报告了社会人口对这些地理差异的影响。因此,我们专注于识别与ESCC相关的风险因素。确定的危险因素被分为5类:吸烟、酒精、饮食因素、环境因素和感染。对每个子类别的危险因素进行了总结和探讨,为这些关联提供了地理联系。这篇综述强调了目前对ESCC的几个危险因素的理解,特别指出了地理联系,并探讨了它们之间联系的潜在解释。然而,需要进一步的研究来验证这些发现,并深入了解它们对肿瘤生物学的影响。
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引用次数: 0
Healthcare Utilization, Costs and Other Outcomes of Peroral Endoscopic Myotomy (POEM) Versus Heller Myotomy in the Inpatient Management of Achalasia in The United States: A 2016 to 2020 Nationwide Study 美国经口内窥镜肌切开术(POEM)与Heller肌切开术在贲门失弛缓症住院治疗中的医疗保健利用率、成本和其他结果:一项2016年至2020年的全国性研究
Pub Date : 2023-10-06 DOI: 10.1177/26345161231202957
Yassine Kilani, Mohammad Aldiabat, Maryam Mubashir, Saqr Alsakarneh, Ammar Arif Vohra, Yazan Aljabiri, Falak Hamo, Fnu Vikash, Vikash Kumar, Salih Samo
Introduction: Per-Oral Endoscopic Myotomy (POEM) is the recommended first-line treatment for all achalasia subtypes due to its minimally invasive nature. We aim to evaluate the trends of utilization, costs, and outcomes (mortality and complications) of POEM versus Heller Myotomy (HM) in U.S. hospitals. Methods: This is a retrospective study of individuals admitted with a primary diagnosis of achalasia. Data was obtained from Nationwide Inpatient Sample databases from the years 2016 to 2020 using ICD-10 codes. We assessed the therapeutic procedures employed, the trends and outcomes associated with POEM versus HM in terms of hospital utilization, mortality, morbidity, and the baseline characteristics of our study population. Results: A total of 26 880 adult individuals were diagnosed with achalasia. Of these, 11% underwent POEM, while 59% underwent HM. POEM rates increased from 6% to 10% of achalasia admissions, while HM decreased from 49% to 41% during the study period. No significant differences in total hospital charges or length of stay were observed between the 2 procedures. Regarding procedural complications, HM was associated with significantly reduced odds of pneumonia (adjusted Odds Ratio [aOR] = 0.09, 95% CI: 0.02-0.41), pneumoperitoneum (aOR = 0.11, 95% CI: 0.03-0.36), and pneumomediastinum (aOR = 0.21, 95% CI: 0.06-0.68), with no difference in the odds of esophageal perforation (aOR = 1.33, 95% CI: 0.27-6.48) and sepsis (aOR = 2.04, 95% CI: 0.22-18.40). Conclusion: While HM rates are currently declining in the U.S., POEM usage appears to be increasing. Despite being a less invasive measure than HM, POEM remains underutilized in the U.S.
经口内窥镜下肌切开术(POEM)由于其微创性,是所有贲门失弛缓症亚型推荐的一线治疗方法。我们的目的是评估美国医院中POEM与Heller肌切开术(HM)的使用趋势、成本和结果(死亡率和并发症)。方法:这是一项对最初诊断为失弛缓症的个体进行的回顾性研究。数据来自2016年至2020年全国住院患者样本数据库,使用ICD-10代码。我们从医院使用率、死亡率、发病率和研究人群的基线特征方面评估了所采用的治疗方法、POEM与HM相关的趋势和结果。结果:共有26880名成年人被诊断为贲门失弛缓症。其中11%行POEM, 59%行HM。在研究期间,贲门失弛缓症的录取率从6%上升到10%,而HM从49%下降到41%。两种治疗方法在总住院费用和住院时间上无显著差异。在手术并发症方面,HM与肺炎(校正比值比[aOR] = 0.09, 95% CI: 0.02-0.41)、气腹(aOR = 0.11, 95% CI: 0.03-0.36)和纵隔气(aOR = 0.21, 95% CI: 0.06-0.68)的发生率显著降低相关,而食管穿孔(aOR = 1.33, 95% CI: 0.27-6.48)和脓毒症(aOR = 2.04, 95% CI: 0.22-18.40)的发生率无差异。结论:虽然HM率目前在美国正在下降,但POEM的使用似乎在增加。尽管POEM的侵入性比HM小,但在美国仍未得到充分利用
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引用次数: 0
Technical Considerations in Improving Delayed Gastric Conduit Emptying After Esophagectomy 改善食管切除术后胃导管延迟排空的技术考虑
Pub Date : 2023-09-29 DOI: 10.1177/26345161231202961
Nathan Alcasid, Jeffrey B. Velotta
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引用次数: 0
Commentary on Medical Therapy for Ineffective Esophageal Motility: A Systematic Review—Surgical Considerations 食道动力不足的药物治疗综述:系统回顾-手术治疗的考虑
Pub Date : 2023-09-07 DOI: 10.1177/26345161231198623
Roger P. Tatum
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引用次数: 0
期刊
Foregut (Thousand Oaks, Calif.)
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