Pub Date : 2023-08-01DOI: 10.1177/26345161231189687
K. DeVault
Esophageal dilation is an important part of endoscopic practice. Proper preparation and technique can optimize outcomes. Techniques include wire guided per oral dilation, blind bougienage and balloon dilation. Fluoroscopy and steroid injections may also be part of endoscopic practice. Diseases that are often and addressed with esophageal dilation include peptic strictures, lower esophageal rings, eosinophilic esophagitis, achalasia and other motility disorders, postoperative dysphagia, radiation induced strictures and malignant strictures. The techniques and approach to all of these disorders will be discussed in this review.
{"title":"Esophageal Dilation: Pearls and Pitfalls","authors":"K. DeVault","doi":"10.1177/26345161231189687","DOIUrl":"https://doi.org/10.1177/26345161231189687","url":null,"abstract":"Esophageal dilation is an important part of endoscopic practice. Proper preparation and technique can optimize outcomes. Techniques include wire guided per oral dilation, blind bougienage and balloon dilation. Fluoroscopy and steroid injections may also be part of endoscopic practice. Diseases that are often and addressed with esophageal dilation include peptic strictures, lower esophageal rings, eosinophilic esophagitis, achalasia and other motility disorders, postoperative dysphagia, radiation induced strictures and malignant strictures. The techniques and approach to all of these disorders will be discussed in this review.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"3 1","pages":"307 - 313"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66050787","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 : 2023-07-18DOI: 10.1177/26345161231188677
Shreya Gupta, James D. Mcdonald, A. J. Rossi, Jonathan M. Hernandez, Jeremy L. Davis, A. Blakely
Gastric mixed adenoneuroendocrine carcinoma (gMANEC) is a histopathologic diagnosis with at least 30% each of exocrine and endocrine components. Although prognosis is thought to be driven by the relative exocrine or endocrine dominance, gMANEC has been clinically treated as gastric adenocarcinoma (gAC). The overall survival of gMANEC as compared to gastric neuroendocrine carcinoma (gNEC) or gAC remains undefined. Using the National Cancer Database, patients with gastric tumors were queried from 2004 to 2016 for gMANEC, gNEC, and gAC histologies. Demographic and clinicopathologic features were recorded. Univariate and multivariate Cox proportional hazards analyses were performed to delineate factors associated with overall survival (OS). Overall, 404 patients diagnosed with gMANEC were identified. Patients had a median age 68 years, were majority male, and predominantly Caucasian. Gastric MANEC was more frequently poorly differentiated (73%vs 52% (gAC) vs 20% (gNEC), P < .001) with lymphovascular invasion (57%vs 38%vs 27%, P < .001) and lymph node involvement (59%vs 49%vs 36%, P < .001); these factors were associated with worse OS on univariable analysis. Finally, tumors >5 cm and lymph node involvement were independent predictors of worse survival. The median OS of patients with gMANEC was 41.5 months. Gastric MANEC and gAC have a similarly dismal prognosis and thus should be continued to treat like gAC. Pathologic nodal metastasis, tumor size and grade are useful prognostic factors.
胃混合性腺神经内分泌癌(gMANEC)是一种组织病理学诊断，外分泌和内分泌成分各至少30%。尽管预后被认为是由外分泌或内分泌的相对优势驱动，但gMANEC在临床上已被视为胃腺癌(gAC)。与胃神经内分泌癌(gNEC)或胃神经内分泌癌(gAC)相比，gMANEC的总生存率尚不明确。使用国家癌症数据库，查询2004年至2016年胃肿瘤患者的gMANEC、gNEC和gAC组织学。记录人口统计学和临床病理特征。进行单因素和多因素Cox比例风险分析，以描述与总生存期(OS)相关的因素。总的来说，404名确诊为gMANEC的患者被确定。患者中位年龄68岁，男性居多，以白种人为主。胃MANEC更常发生低分化(73%vs 52% (gAC) vs 20% (gNEC)， p5cm和淋巴结受累是生存差的独立预测因素。gMANEC患者的中位生存期为41.5个月。胃MANEC和gAC预后相似，因此应继续像gAC一样治疗。病理淋巴结转移、肿瘤大小和分级是有用的预后因素。
{"title":"Survival Trends and Profiling of Gastric Mixed Adenoneuroendocrine Carcinoma (gMANEC) in the Current Era","authors":"Shreya Gupta, James D. Mcdonald, A. J. Rossi, Jonathan M. Hernandez, Jeremy L. Davis, A. Blakely","doi":"10.1177/26345161231188677","DOIUrl":"https://doi.org/10.1177/26345161231188677","url":null,"abstract":"Gastric mixed adenoneuroendocrine carcinoma (gMANEC) is a histopathologic diagnosis with at least 30% each of exocrine and endocrine components. Although prognosis is thought to be driven by the relative exocrine or endocrine dominance, gMANEC has been clinically treated as gastric adenocarcinoma (gAC). The overall survival of gMANEC as compared to gastric neuroendocrine carcinoma (gNEC) or gAC remains undefined. Using the National Cancer Database, patients with gastric tumors were queried from 2004 to 2016 for gMANEC, gNEC, and gAC histologies. Demographic and clinicopathologic features were recorded. Univariate and multivariate Cox proportional hazards analyses were performed to delineate factors associated with overall survival (OS). Overall, 404 patients diagnosed with gMANEC were identified. Patients had a median age 68 years, were majority male, and predominantly Caucasian. Gastric MANEC was more frequently poorly differentiated (73%vs 52% (gAC) vs 20% (gNEC), P < .001) with lymphovascular invasion (57%vs 38%vs 27%, P < .001) and lymph node involvement (59%vs 49%vs 36%, P < .001); these factors were associated with worse OS on univariable analysis. Finally, tumors >5 cm and lymph node involvement were independent predictors of worse survival. The median OS of patients with gMANEC was 41.5 months. Gastric MANEC and gAC have a similarly dismal prognosis and thus should be continued to treat like gAC. Pathologic nodal metastasis, tumor size and grade are useful prognostic factors.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46997543","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 : 2023-07-17DOI: 10.1177/26345161231175981
E. Griffiths, S. Kamarajah
Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4% had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7%vs 7.5%, P < .001) and less likely to have achieve a composite outcome (57.8%vs 73.4%, P < .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5% vs 3.4%; OR: 0.98, CI95%: 0.69-1.37) or anastomotic leak rate (10.9% vs 10.2%%; OR: 1.11, CI95%: 0.90-1.37) but higher reoperation rates (13.6% vs 10.4%; OR: 1.59, CI95%: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system “stress” are key to minimizing future harm from treatment delay for OG cancer patients.
本研究旨在描述食管胃癌(OG)患者的预后，并将围手术期预后与大流行前的数据进行比较。方法:本分析纳入三项国际前瞻性队列研究。首先，covid -外科-癌症(n = 1999)包括从大流行开始至2020年4月14日计划进行手术的OG癌患者，随访至2020年8月31日。将治疗途径和结果与大流行前接受OG癌治疗的患者、食管胃吻合审计(OGAA, n = 2246)和GlobalSurg 3 (n = 1256)研究进行比较。手术综合结果定义为患者获得边缘阴性切除、可切除性和无术后死亡率。结果:本研究纳入1999例COVID-19大流行期间的患者，其中32.4%的患者发生了大流行前标准管理的变化。延迟手术患者的无手术率(24.7%vs 7.5%， P < 0.001)明显高于未延迟手术的患者，而获得综合预后的可能性较低(57.8%vs 73.4%， P < 0.001)。30天死亡率无显著差异(3.5% vs 3.4%;OR: 0.98, CI95%: 0.69-1.37)或吻合口漏率(10.9% vs 10.2%;OR: 1.11, CI95%: 0.90-1.37)，但再手术率较高(13.6% vs 10.4%;OR: 1.59, CI95%: 1.30-1.92)。结论:大流行似乎导致了管理途径的广泛改变，影响了三分之一的患者。对于OG癌患者来说，开发选择性手术路径以适应系统“应激”期是减少治疗延迟对未来伤害的关键。
{"title":"Impact of the SARS-CoV-2 Pandemic on Treatment Pathways and Outcomes of Esophagogastric Cancer: A Pre- Versus Post-Pandemic Comparison of International Prospective Cohort Data","authors":"E. Griffiths, S. Kamarajah","doi":"10.1177/26345161231175981","DOIUrl":"https://doi.org/10.1177/26345161231175981","url":null,"abstract":"Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4% had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7%vs 7.5%, P < .001) and less likely to have achieve a composite outcome (57.8%vs 73.4%, P < .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5% vs 3.4%; OR: 0.98, CI95%: 0.69-1.37) or anastomotic leak rate (10.9% vs 10.2%%; OR: 1.11, CI95%: 0.90-1.37) but higher reoperation rates (13.6% vs 10.4%; OR: 1.59, CI95%: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system “stress” are key to minimizing future harm from treatment delay for OG cancer patients.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90313877","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 : 2023-07-12DOI: 10.1177/26345161231185780
Hillary Wilson, K. Verhoeff, J. Dang, J. Kung, N. Switzer, D. Birch, K. Madsen, S. Karmali, V. Mocanu
The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a systematic review to characterize and evaluate the safety and efficacy of bariatric surgery in IBD patients. A medical librarian developed and executed comprehensive searches on November 2, 2021. The population of interest was adult subjects (>18 years) diagnosed with inflammatory bowel disease (IBD) undergoing any type of bariatric surgery. Meta-analysis was used to evaluate outcomes using RevMan 5.4.1. A total of 330 687 patients were identified within the 11 studies included. Within all included studies there were 1595 patients with IBD. Patients had a mean weighted age of 46.0, with a female predominance (n = 1287, 80.7%). The mean duration of follow up was 39.7 months. Metabolic and anthropometric outcomes were only reported in noncomparative studies evaluating only patients with IBD, limiting the ability to complete meta-analysis. Meta-analysis revealed that IBD was associated with increased rates of postoperative complications (RR 2.14; 95% CI 1.87-2.44; P < .00001) in comparison to controls without IBD. While bariatric surgery presents an effective weight loss option for patients with IBD, these patients are associated with higher rates of postoperative complications. This work highlights the need to better delineate the effect of bariatric procedures for patients with IBD with respect to both metabolic and IBD-related outcomes.
{"title":"Safety and Outcomes of Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis","authors":"Hillary Wilson, K. Verhoeff, J. Dang, J. Kung, N. Switzer, D. Birch, K. Madsen, S. Karmali, V. Mocanu","doi":"10.1177/26345161231185780","DOIUrl":"https://doi.org/10.1177/26345161231185780","url":null,"abstract":"The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a systematic review to characterize and evaluate the safety and efficacy of bariatric surgery in IBD patients. A medical librarian developed and executed comprehensive searches on November 2, 2021. The population of interest was adult subjects (>18 years) diagnosed with inflammatory bowel disease (IBD) undergoing any type of bariatric surgery. Meta-analysis was used to evaluate outcomes using RevMan 5.4.1. A total of 330 687 patients were identified within the 11 studies included. Within all included studies there were 1595 patients with IBD. Patients had a mean weighted age of 46.0, with a female predominance (n = 1287, 80.7%). The mean duration of follow up was 39.7 months. Metabolic and anthropometric outcomes were only reported in noncomparative studies evaluating only patients with IBD, limiting the ability to complete meta-analysis. Meta-analysis revealed that IBD was associated with increased rates of postoperative complications (RR 2.14; 95% CI 1.87-2.44; P < .00001) in comparison to controls without IBD. While bariatric surgery presents an effective weight loss option for patients with IBD, these patients are associated with higher rates of postoperative complications. This work highlights the need to better delineate the effect of bariatric procedures for patients with IBD with respect to both metabolic and IBD-related outcomes.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47529241","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 : 2023-07-08DOI: 10.1177/26345161231181357
J. Kothadia, C. Howden
Current treatments for gastroesophageal reflux disease (GERD) and other acid-related disorders either block stimulation of the parietal cell (H2-receptor antagonists) or inhibit gastric H+/K+-ATPase (proton pump inhibitors; PPIs). PPIs are usually very effective in healing esophageal erosions and improving heartburn in patients with GERD. However, the PPIs have a slow onset of action and do not provide complete symptom resolution in all patients. Therefore, there is a need for agents that offer a fast onset of action and sustained acid suppression to maximize both mucosal healing and symptom control. Potassium-competitive acid blockers (P-CABs) are a relatively novel class of acid suppressants showing potential for the management of GERD and other acid-related disorders. This article focuses on the likely role of P-CABs for treating GERD.
{"title":"Potassium-Competitive Acid Blockers for the Treatment of Gastroesophageal Reflux Disease","authors":"J. Kothadia, C. Howden","doi":"10.1177/26345161231181357","DOIUrl":"https://doi.org/10.1177/26345161231181357","url":null,"abstract":"Current treatments for gastroesophageal reflux disease (GERD) and other acid-related disorders either block stimulation of the parietal cell (H2-receptor antagonists) or inhibit gastric H+/K+-ATPase (proton pump inhibitors; PPIs). PPIs are usually very effective in healing esophageal erosions and improving heartburn in patients with GERD. However, the PPIs have a slow onset of action and do not provide complete symptom resolution in all patients. Therefore, there is a need for agents that offer a fast onset of action and sustained acid suppression to maximize both mucosal healing and symptom control. Potassium-competitive acid blockers (P-CABs) are a relatively novel class of acid suppressants showing potential for the management of GERD and other acid-related disorders. This article focuses on the likely role of P-CABs for treating GERD.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47327139","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 : 2023-06-22DOI: 10.1177/26345161231180010
Nisarg Mehta, Sven E. Eriksson, P. Zheng, I. Sarici, A. Zaidi, B. Jobe, S. Ayazi
Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P <0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P <0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P < 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P <0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P <0 .0001). The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.
{"title":"Abdominal Wall Hernias in Patients with Hiatal Hernias: Predictors of Association in a Large Cohort of Patients","authors":"Nisarg Mehta, Sven E. Eriksson, P. Zheng, I. Sarici, A. Zaidi, B. Jobe, S. Ayazi","doi":"10.1177/26345161231180010","DOIUrl":"https://doi.org/10.1177/26345161231180010","url":null,"abstract":"Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P <0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P <0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P < 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P <0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P <0 .0001). The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49595830","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 : 2023-06-21DOI: 10.1177/26345161231182108
Malhar J. Parikh, Nielsen M. Gabriel, V. Gryszko, C. Erkmen
Esophageal cancer carries an immense burden of disease. Despite advances in cancer care, the survival rate of esophageal cancer has not significantly improved over the last 30 years. The burden of disease is greater on minorities, immigrants, and lower socioeconomic groups in the United States. Research has consistently shown that these communities suffer from persistently worse outcomes. Minorities are noted to have increased risk of developing esophageal cancer, have worse stage at presentation, and limited access to the newest advancements and best treatment options. The reason for these disparities is multifactorial and the US health system must address and correct the underlying reasons to ensure just health care for all.
{"title":"Understanding the Spectrum of Esophageal Cancer Disparities","authors":"Malhar J. Parikh, Nielsen M. Gabriel, V. Gryszko, C. Erkmen","doi":"10.1177/26345161231182108","DOIUrl":"https://doi.org/10.1177/26345161231182108","url":null,"abstract":"Esophageal cancer carries an immense burden of disease. Despite advances in cancer care, the survival rate of esophageal cancer has not significantly improved over the last 30 years. The burden of disease is greater on minorities, immigrants, and lower socioeconomic groups in the United States. Research has consistently shown that these communities suffer from persistently worse outcomes. Minorities are noted to have increased risk of developing esophageal cancer, have worse stage at presentation, and limited access to the newest advancements and best treatment options. The reason for these disparities is multifactorial and the US health system must address and correct the underlying reasons to ensure just health care for all.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44065815","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 : 2023-06-04DOI: 10.1177/26345161231176080
Aryan Meknat, A. Kulkarni, Thaer Abdelfatteh, H. C. Fernando
There are a wide variety of surgical therapeutic options for GERD—ranging from laparoscopic fundoplication, magnetic sphincter augmentation, to advanced endoscopic interventions (eg, transoral incisionless fundoplication, TIF). TIF has emerged as the predominant endoscopic approach for GERD, supported by several randomized trials highlighting the efficacy of this procedure. Its safety profile has similarly been well established. The key to properly utilizing this procedure is patient selection. We here in describe the efficacy, highlight key decision making and technical aspects of performing a TIF, to discuss post-operative care and complications.
{"title":"Key Decision Making and Technical Aspects of Performing Transoral Incisionless Fundoplication","authors":"Aryan Meknat, A. Kulkarni, Thaer Abdelfatteh, H. C. Fernando","doi":"10.1177/26345161231176080","DOIUrl":"https://doi.org/10.1177/26345161231176080","url":null,"abstract":"There are a wide variety of surgical therapeutic options for GERD—ranging from laparoscopic fundoplication, magnetic sphincter augmentation, to advanced endoscopic interventions (eg, transoral incisionless fundoplication, TIF). TIF has emerged as the predominant endoscopic approach for GERD, supported by several randomized trials highlighting the efficacy of this procedure. Its safety profile has similarly been well established. The key to properly utilizing this procedure is patient selection. We here in describe the efficacy, highlight key decision making and technical aspects of performing a TIF, to discuss post-operative care and complications.","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"3 1","pages":"332 - 337"},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66050441","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 : 2023-06-02DOI: 10.1177/26345161231178348
L. Schaheen, R. Bremner
Reoperative antireflux surgery (ARS) is complex and often needs to be customized to the individual patient. A transthoracic approach is preferred in select patients with concomitant esophageal pathologies or a complex surgical history. The clinical presentation and perioperative evaluation of patients who require reoperative ARS as well as surgical options, the role of the transthoracic approach, and Nissen and Belsey Mark IV fundoplication techniques are discussed in detail. Outcomes associated with the transthoracic approach to reoperative ARS are reviewed. Although less invasive laparoscopic approaches have become more common, the transthoracic approach must remain in the foregut surgeon’s armamentarium.
再手术抗反流手术(ARS)是复杂的，往往需要为个别患者定制。经胸入路是选择合并食管病变或有复杂手术史的患者的首选方法。本文详细讨论了需要再手术ARS患者的临床表现和围手术期评估、手术选择、经胸入路的作用以及Nissen和Belsey Mark IV基底复制技术。回顾经胸入路再手术ARS的相关结果。虽然侵入性较小的腹腔镜入路已经变得越来越普遍，但经胸入路仍然是前肠外科医生的首选。
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