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Systematic Reviews Jan 2020Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with... (Review)
Review
Screening for esophageal adenocarcinoma and precancerous conditions (dysplasia and Barrett's esophagus) in patients with chronic gastroesophageal reflux disease with or without other risk factors: two systematic reviews and one overview of reviews to inform a guideline of the Canadian Task Force on...
BACKGROUND
Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease (GERD) without alarm symptoms. The goal was to systematically review three key questions (KQs): (1) The effectiveness of screening for these conditions; (2) How adults with chronic GERD weigh the benefits and harms of screening, and what factors contribute to their preferences and decision to undergo screening; and (3) Treatment options for Barrett's esophagus (BE), dysplasia or stage 1 EAC (overview of reviews).
METHODS
Bibliographic databases (e.g. Ovid MEDLINE®) were searched for each review in October 2018. We also searched for unpublished literature (e.g. relevant websites). The liberal accelerated approach was used for title and abstract screening. Two reviewers independently screened full-text articles. Data extraction and risk of bias assessments were completed by one reviewer and verified by another reviewer (KQ1 and 2). Quality assessments were completed by two reviewers independently in duplicate (KQ3). Disagreements were resolved through discussion. We used various risk of bias tools suitable for study design. The GRADE framework was used for rating the certainty of the evidence.
RESULTS
Ten studies evaluated the effectiveness of screening. One retrospective study reported no difference in long-term survival (approximately 6 to 12 years) between those who had a prior esophagogastroduodenoscopy and those who had not (adjusted HR 0.93, 95% confidence interval (CI) 0.58-1.50). Though there may be higher odds of a stage 1 diagnosis than a more advanced diagnosis (stage 2-4) if an EGD had been performed in the previous 5 years (OR 2.27, 95% CI 1.00-7.67). Seven studies compared different screening modalities, and showed little difference between modalities. Three studies reported on patients' unwillingness to be screened (e.g. due to anxiety, fear of gagging). Eleven systematic reviews evaluated treatment modalities, providing some evidence of early treatment effect for some outcomes.
CONCLUSIONS
Little evidence exists on the effectiveness of screening and values and preferences to screening. Many treatment modalities have been evaluated, but studies are small. Overall, there is uncertainty in understanding the effectiveness of screening and early treatments.
SYSTEMATIC REVIEW REGISTRATIONS
PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
Topics: Adenocarcinoma; Barrett Esophagus; Early Diagnosis; Endoscopy, Digestive System; Esophageal Neoplasms; Gastroesophageal Reflux; Humans; Practice Guidelines as Topic; Precancerous Conditions; Risk Factors; Survival Rate; Systematic Reviews as Topic
PubMed: 31996261
DOI: 10.1186/s13643-020-1275-2 -
International Journal of Surgery Case... May 2023Duplication of the alimentary tract are uncommon congenital malformations that may be found anywhere from mouth to anus. Esophageal cystic duplication is a congenital...
INTRODUCTION AND IMPORTANCE
Duplication of the alimentary tract are uncommon congenital malformations that may be found anywhere from mouth to anus. Esophageal cystic duplication is a congenital cystic malformation of the alimentary tract consisting of a duplication of the segment of the esophagus to which it is adjacent.
CASE PRESENTATION
We report the case of a 29-year-old female who had complained of intermittent epigastric pain and post prandial nausea for several weeks. Physical examination was without particularity except for the presence of abdominal epigastric mass. Transabdominal sonography combined with CT scan showed an epigastric cyst with no topographic relation to the pancreas measuring about 80 mm in diameter. Because of persistence of the epigastric pain and the nausea we decided to operate the patient. Histological exam than showed that the cystic mass was in fact an esophageal cystic duplication with no histological signs of malignancy.
CLINICAL DISCUSSION
Here we describe a case of intra-abdominal esophageal duplication cyst in adult patient. Most of duplications cause symptoms in infancy or early childhood. Digestive duplication revealed at adulthood is a condition considered rare.
CONCLUSION
Esophageal duplication cysts are uncommon developmental lesions arising from the primitive foregut, when diagnosed or encountered incidentally. The diagnosis of this anomaly in adulthood is exceptional and requires surgery.
PubMed: 37156202
DOI: 10.1016/j.ijscr.2023.108295 -
Toxics Feb 2023N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work... (Review)
Review
N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population. We conducted a systematic review and meta-analysis to investigate the links between nitrate, nitrite, and NOCs in food and water and the risk of gastrointestinal (GI) cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), and pancreatic cancer (PC). A systematic search of the literature in Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase was performed for studies on the association between NOCs in drinking water and food sources and GI cancers. Forest plots of relative risk (RR) were constructed for all the cancer sites and the intake sources. The random-effects model was used to assess the heterogeneity between studies. Forty articles were included after removing duplicate and irrelevant articles. The meta-analysis indicated that the intake of high dose vs. low dose of these compounds was significantly associated with the overall GI cancer risk and nitrite (RR = 1.18, 95% CI = 1.07-1.29), and N-nitrosodimethylamine (NDMA) (RR = 1.32, 95% CI = 1.06-1.65). We found that dietary nitrite intake increased GC (RR = 1.33, 95% CI = 1.02-1.73), and EC (RR = 1.38, 95% CI = 1.01-1.89). Additionally, dietary NDMA intake increased the risk of CRC (RR = 1.36, 95% CI = 1.18-1.58). This meta-analysis provides some evidence that the intake of dietary and water nitrate, nitrite, and NOCs may be associated with GI cancers. In particular, dietary nitrite is linked to GC and EC risks and dietary NDMA intake is associated with CRC.
PubMed: 36851064
DOI: 10.3390/toxics11020190 -
World Journal of Gastroenterology Jul 2015To investigate the prevalence and the clinical characteristics of Asian patients with eosinophilic esophagitis. (Review)
Review
AIM
To investigate the prevalence and the clinical characteristics of Asian patients with eosinophilic esophagitis.
METHODS
We conducted a systematic search of the PubMed and Web of Science databases for original studies, case series, and individual case reports of eosinophilic esophagitis in Asian countries published from January 1980 to January 2015. We found 66 and 80 articles in the PubMed and Web of Science databases, respectively; 24 duplicate articles were removed. After excluding animal studies, articles not written in English, and meeting abstracts, 25 articles containing 217 patients were selected for analysis.
RESULTS
Sample size-weighted mean values were determined for all pooled prevalence data and clinical characteristics. The mean age of the adult patients with eosinophilic esophagitis was approximately 50 years, and 73% of these patients were male. They frequently presented with allergic diseases including bronchial asthma, allergic rhinitis, food allergy, and atopic dermatitis. Bronchial asthma was the most frequent comorbid allergic disease, occurring in 24% of patients with eosinophilic esophagitis. Dysphagia was the primary symptom reported; 44% of the patients complained of dysphagia. Although laboratory blood tests are not adequately sensitive for an accurate diagnosis of eosinophilic esophagitis, endoscopic examinations revealed abnormal findings typical of this disease, including longitudinal furrows and concentric rings, in 82% of the cases. One-third of the cases responded to proton pump inhibitor administration.
CONCLUSION
The characteristics of eosinophilic esophagitis in Asian patients were similar to those reported in Western patients, indicating that this disease displays a similar pathogenesis between Western and Asian patients.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Asia; Asian People; Asthma; Child; Child, Preschool; Comorbidity; Deglutition Disorders; Eosinophilic Esophagitis; Female; Humans; Infant; Male; Middle Aged; Prevalence; Proton Pump Inhibitors; Sex Factors; Treatment Outcome; Young Adult
PubMed: 26217096
DOI: 10.3748/wjg.v21.i27.8433 -
Korean Journal of Radiology Jan 2021Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed... (Review)
Review
Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
Topics: Humans; Image Interpretation, Computer-Assisted; Lymphoma; Magnetic Resonance Imaging; Mediastinal Cyst; Mediastinal Neoplasms; Mediastinum; Societies, Medical; Thymoma; Thymus Hyperplasia
PubMed: 32783412
DOI: 10.3348/kjr.2019.0897 -
Journal of Assisted Reproduction and... Aug 2019While mitotic errors commonly cause aneuploid clones soon after conception, the embryos often normalize as clones are rapidly eliminated. Although generally considered... (Review)
Review
While mitotic errors commonly cause aneuploid clones soon after conception, the embryos often normalize as clones are rapidly eliminated. Although generally considered benign, evidence suggests clone elimination as the primary cause of the vertebral, ano-rectal, cardiac, tracheo-esophageal, renal, and limb (VACTERL) association of anomalies, and possibly other adverse outcomes as well. Here, clone elimination-related development disruption at specific locations is used as the basis of a comprehensive theoretical VACTERL association model that also elucidates mitotic mosaic aneuploidy effects. For the association, the model explains random temporal and spatial origins during a limited time frame and overlapping clusters of component anomalies. It supports early developmental effects involving the stage of determination, where the position in a specific morphogen field controls what a cell will become and where it will be located. Developmental properties related to determination also create specific vulnerabilities to the midline and distal defects, the latter explaining exclusively radial and tibial defects with duplications and deficiencies. The model also supports isolated anomalies as part of the association and, for mosaic mitotic aneuploidy, indicates that clone elimination nears completion at the time of lower limb determination. Although mosaic clone elimination may cause other defects, occurrences in different developmental fields separate them from VACTERL anomalies. Clone elimination may also be related to risks for a single umbilical artery and for non-structural adverse pregnancy outcomes such as losses, prematurity, and growth delays, while a paucity of clone lethality in non-humans explains the rarity of the association and of single umbilical arteries in animals.
Topics: Abnormalities, Multiple; Anal Canal; Aneuploidy; Animals; Embryo, Mammalian; Embryo, Nonmammalian; Esophagus; Female; Heart Defects, Congenital; Kidney; Limb Deformities, Congenital; Pregnancy; Spine; Trachea
PubMed: 31129863
DOI: 10.1007/s10815-019-01485-y -
Journal of Thoracic Disease Mar 2023In both clinical practice and residency training, the use of robotic platforms in surgery is becoming more common. The aim of this study was to perform a systematic... (Review)
Review
BACKGROUND
In both clinical practice and residency training, the use of robotic platforms in surgery is becoming more common. The aim of this study was to perform a systematic review of the perioperative outcomes of robotic and laparoscopic paraesophageal hernia (PEH) repair.
METHODS
The PRISMA statement guidelines were used to perform this systematic review. We conducted a database search which included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. There were 384 articles discovered in the initial search using various keywords. From those 384 articles, after duplicates were removed and publications were eliminated based on eligibility criteria, 7 publications were then chosen for analysis. Risk of bias was assessed using Cochrane Risk of Bias Assessment Tool. Narrative synthesis of results has been provided.
RESULTS
When compared to standard laparoscopic approaches, robotic surgery for large PEHs may offer benefits in terms of decreased conversion rate and shorter hospital stay. Some studies found a decrease in need for esophageal lengthening procedures and fewer long-term recurrences. The perioperative complication rate is similar between the two techniques in most studies; however, one large study of nearly 170,000 patients in the early years of robotics adoption demonstrated a higher rate of esophageal perforation and respiratory failure in the robotic group (2.2% increase in absolute risk). Cost is another disadvantage of robotic repair when compared to laparoscopic repair. Our study is limited by the non-randomized and retrospective nature of the studies.
CONCLUSIONS
More studies into recurrence rates and long-term complications are needed to determine the efficacy of robotic versus laparoscopic PEHs repair.
PubMed: 37065589
DOI: 10.21037/jtd-22-819 -
Case Reports in Surgery 2015Duplication of the alimentary tract is a rare congenital malformation that occurs most often in the abdominal region, whereas esophageal duplication cyst develops...
Duplication of the alimentary tract is a rare congenital malformation that occurs most often in the abdominal region, whereas esophageal duplication cyst develops typically in the thoracic region but occasionally in the neck and abdominal regions. Esophageal duplication cyst is usually diagnosed in early childhood because of symptoms related to bleeding, infection, and displacement of tissue surrounding the lesion. We recently encountered a rare adult case of esophageal duplication cyst in the abdominal esophagus. A 50-year-old man underwent gastroscopy, endoscopic ultrasonography, computed tomography, and magnetic resonance imaging to investigate epigastric pain and dysphagia that started 3 months earlier. Imaging findings suggested esophageal duplication cyst, and the patient underwent laparoscopic resection followed by intraoperative esophagoscopy to reconstruct the esophagus safely and effectively. Histopathological examination of the resected specimen revealed two layers of smooth muscle in the cystic wall, confirming the diagnosis of esophageal duplication cyst.
PubMed: 25883826
DOI: 10.1155/2015/940768 -
World Journal of Gastrointestinal... Jan 2016According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million... (Review)
Review
According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.
PubMed: 26843911
DOI: 10.4240/wjgs.v8.i1.27 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... May 2022The difficulty of surgery, which is related to surgical safety, has only been mentioned as a subjective perception for a long time. There are few studies to...
OBJECTIVES
The difficulty of surgery, which is related to surgical safety, has only been mentioned as a subjective perception for a long time. There are few studies to quantitatively and systematically evaluate the difficulty of thoracic surgery. This study aims to establish a quantitative evaluation index system for thoracic surgical difficulty, and to evaluate its reliability and validity.
METHODS
During the 2 national thoracic surgery academic conferences, the factors that may affect the difficulty of thoracic surgery were evaluated by the thoracic surgeons via semi open questionnaires, and then the evaluation item pool of thoracic surgery difficulty was established. The importance of each indicator in the evaluation item pool was graded by 2 rounds of Delphi method. The average score, full score rate and coefficient of variation of each index were calculated, and the composite index method was used to decide whether to delete the indicator.Finally, the difficulty evaluation scale of thoracic surgery was constructed. The surgical data of patients with thoracic tumors were collected. The scale was used to evaluate the difficulty of thoracic surgery for lung, esophageal, and mediastinal tumors. The reliability and validity of the scale were evaluated by the commonly used difficulty evaluation indexes: Operation time, intraoperative estimated blood loss, Visual Analog Scale (VAS), side injury rate, and blood transfusion rate as standards.
RESULTS
A total of 230 questionnaires were distributed in the 2 rounds of survey, and 149 valid questionnaires were collected after eliminating duplicate questionnaires. Through 2 rounds of Delphi consultation with 20 experts, the difficulty evaluation indexes were scored and screened, and the difficulty evaluation scale of thoracic surgery was established. It included 5 main indexes (surgical decision-making, operation space, separation interface, reconstruction method, and surgical materials) and 16 secondary indexes [American Society of Anesthesiologists (ASA) classification, surgical trauma, operator experience, space size, space depth, space source, space adjacent, interface content, anatomical gap, visual field, interface size, reconstruction complexity, reconstruction scope, autologous materials, artificial biomaterials and instruments]. After weighting, the total score of Thoracic Surgery Difficulty Evaluation Scale was from 1 to 3. A Score at 1 standed for simplicity, and score at 3 standed for difficulty. Further data were collected for 127 cases of thoracic tumor surgery. The difficulty scores of surgery for lung, esophageal, and mediastinal tumor were 1.69±0.26, 1.86±0.18, and 1.56±0.31, respectively, and the Cronbach's α coefficients of the scale in 3 tumor surgeries were 0.993, 0.974, and 0.989, repectively, and the Spearman Brown coefficients were 0.996, 0.984, and 0.996, respectively. The Spearman correlation coefficients of operation difficulty score with operation time, estimated blood loss, and VAS were 0.360 and 0.634, 0.632 and 0.578, 0.696 and 0.875, respectively (all <0.05). The incidence of postoperative complications in the difficult operation group (difficulty score >1.85) was higher than that in the non-difficult operation group (=0.02).
CONCLUSIONS
The quantitative Thoracic Surgical Difficulty Assessment Scale has been successfully established, which shows good reliability and validity in thoracic tumor surgery. The Thoracic Surgical Difficulty Assessment Scale has broad application prospects in reducing the difficulty of the surgery, controlling surgical complications, and training surgeons.
Topics: Delphi Technique; Humans; Pain Measurement; Postoperative Complications; Reproducibility of Results; Surveys and Questionnaires
PubMed: 35753736
DOI: 10.11817/j.issn.1672-7347.2022.200782