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Gastroenterology May 2015The large increase in the incidence of esophageal adenocarcinoma in the West during the past 30 years has stimulated interest in screening for Barrett's esophagus (BE),... (Review)
Review
The large increase in the incidence of esophageal adenocarcinoma in the West during the past 30 years has stimulated interest in screening for Barrett's esophagus (BE), a precursor to esophageal cancer. Effective endoscopic treatments for dysplasia and intramucosal cancer, coupled with screening programs to detect BE, could help reverse the increase in the incidence of esophageal cancer. However, there are no accurate, cost-effective, minimally invasive techniques available to screen for BE, reducing the enthusiasm of gastroenterologists. Over the past 5 years, there has been significant progress in the development of screening technologies. We review existing and developing technologies, new minimally invasive imaging techniques, nonendoscopic devices for cell collection, and biomarkers that can be measured in blood or stool samples. We discuss the status of these approaches, data from clinical studies of their effects, and their anticipated strengths and weaknesses in screening. The area is rapidly evolving, and new tools will soon be ready for prime time.
Topics: Adenocarcinoma; Barrett Esophagus; Biomarkers; Biopsy; Capsule Endoscopy; Equipment Design; Esophageal Neoplasms; Esophagoscopes; Esophagoscopy; Humans; Mass Screening; Precancerous Conditions; Predictive Value of Tests; Risk Assessment; Risk Factors
PubMed: 25701083
DOI: 10.1053/j.gastro.2015.02.012 -
Frontiers in Oncology 2022Esophageal mucoepidermoid carcinoma (EMEC) is a rare disease. The biological behavior and treatment of this malignancy are not well established. (Review)
Review
BACKGROUND
Esophageal mucoepidermoid carcinoma (EMEC) is a rare disease. The biological behavior and treatment of this malignancy are not well established.
METHODS
Data from 58 patients with EMEC who underwent esophagectomy were retrospectively analyzed and compared with 5028 patients with esophageal squamous cell carcinoma (ESCC). Kaplan-Meier and multivariate Cox regression analyses were conducted to investigate the association between clinicopathological factors and survival.
RESULTS
The study cohort included 36 males and 22 females with a median age of 59 years (range, 40-78 years). Of the 47 patients who underwent preoperative esophagoscopic biopsy, only 1 patient was diagnosed with EMEC. EMEC was more often found in female patients (39.7% versus 25.8%, P=0.036) and patients with EMEC had a significantly lower rate of lymph node metastasis (25.0% versus 49.4%, P<0.001) than patients with ESCC. After 1:1 propensity score matching, the 5-year overall survival rate of 55.2% for patients with EMEC was similar to that of 61.9% for patients with ESCC (P=0.399).
CONCLUSIONS
EMEC is a rare disease that more often affects females and these patients has less lymph node metastasis than patients with ESCC. Preoperative esophagoscopic biopsy has difficulty obtaining an accurate pathological diagnosis for EMEC patients. The prognosis for EMEC is similar to that for ESCC.
PubMed: 35494060
DOI: 10.3389/fonc.2022.836352 -
Canadian Journal of Gastroenterology &... 2019Endoscopic resection has been worldwide recognized as a treatment strategy for early esophageal lesions. The occurrence of esophageal stricture after endoscopic... (Review)
Review
BACKGROUND AND PURPOSES
Endoscopic resection has been worldwide recognized as a treatment strategy for early esophageal lesions. The occurrence of esophageal stricture after endoscopic resection will reduce the quality of life of patients. This study will evaluate the efficacy and safety of steroids in the prevention of esophageal stricture after endoscopic resection and the influence of different steroid administration methods.
METHODS
In the relevant literature database, literature from 2008 to 2018 is retrieved by using preset keywords, the search results are carefully screened, and the conclusion of the literature is synthesized to form arguments and draw conclusions.
RESULTS
73 articles met our requirements. Oral steroid administration, not prophylactic endoscopic balloon dilation alone, was effective in preventing esophagostenosis after esophagoscopic treatment and reducing the number of repeated endoscopic balloon dilations even after extensive endoscopic resection. Local steroid injection is useful and economy for preventing esophageal stricture, even though it may raise the risk of perforation during dilations. A wider range of circumferential mucosal defects is an independent predictor for stricture formation for patents given preventive steroid injections after endoscopic submucosal dissection. For complete circular mucosal defect, the further researches are essential to investigate the role of local steroid injection. The effect of other methods such as steroid gel, intravenous infusion of steroid, and novel steroid filling methods require more confirmation.
CONCLUSIONS
Therefore, steroids play an irreplaceable role in preventing esophageal stricture after endoscopic resection. Oral and local injections of steroids are the two most acceptable methods and more prospective studies are needed to compare the effectiveness and safety of these two methods.
Topics: Animals; Endoscopic Mucosal Resection; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Glucocorticoids; Humans; Postoperative Complications; Quality of Life
PubMed: 31058109
DOI: 10.1155/2019/5380815 -
World Journal of Gastroenterology Jun 2014Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has... (Review)
Review
Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies, allowing the non-invasive study of the entire mucosa. This has led, together with new technical advances, to the creation of two new models (PillCam ESO and PillCam Colon) for the study of esophageal and colonic diseases. These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts, because traditional endoscopy is often unpleasant and uncomfortable for the patient, can be painful, often requires moderate or deep sedation and is not without complications (hemorrhage, perforation, etc.). PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps, and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening, even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy. This article discusses the advantages of capsule endoscopy over conventional endoscopy, its current application possibilities and indications in routine clinical practice. In the various sections of the work, we assess the application of endoscopic capsule in different sections of the digestive tract (esophagus, stomach, and colon) and finally the potential role of panendoscopy with PillCam Colon.
Topics: Capsule Endoscopes; Capsule Endoscopy; Colonoscopes; Colonoscopy; Equipment Design; Esophagoscopes; Esophagoscopy; Gastroscopes; Gastroscopy; Health Knowledge, Attitudes, Practice; Humans; Patients; Predictive Value of Tests; Treatment Refusal
PubMed: 24966612
DOI: 10.3748/wjg.v20.i23.7424 -
World Journal of Gastrointestinal... Mar 2015Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research,... (Review)
Review
Congenital esophageal stenosis (CES) is an extremely rare malformation, and standard treatment have not been completely established. By years of clinical research, evidence has been accumulated. We conducted systematic review to assess outcomes of the treatment for CES, especially the role of endoscopic modalities. A total of 144 literatures were screened and reviewed. CES was categorized in fibromuscular thickening, tracheobronchial remnants (TBR) and membranous web, and the frequency was 54%, 30% and 16%, respectively. Therapeutic option includes surgery and dilatation, and surgery tends to be reserved for ineffective dilatation. An essential point is that dilatation for TBR type of CES has low success rate and high rate of perforation. TBR can be distinguished by using endoscopic ultrasonography (EUS). Overall success rate of dilatation for CES with or without case selection by using EUS was 90% and 29%, respectively. Overall rate of perforation with or without case selection was 7% and 24%, respectively. By case selection using EUS, high success rate with low rate of perforation could be achieved. In conclusion, endoscopic dilatation has been established as a primary therapy for CES except TBR type. Repetitive dilatation with gradual step-up might be one of safe ways to minimize the risk of perforation.
PubMed: 25789088
DOI: 10.4253/wjge.v7.i3.183 -
Digestion 2018Impaired esophageal mucosal integrity plays a role in causing symptoms of gastroesophageal reflux disease (GERD). Recently, the assessment of esophageal baseline... (Review)
Review
BACKGROUND
Impaired esophageal mucosal integrity plays a role in causing symptoms of gastroesophageal reflux disease (GERD). Recently, the assessment of esophageal baseline impedance (BI) using the multichannel intraluminal impedance-pH (MII-pH) test was suggested as a surrogate technique for the study of esophageal mucosal integrity and was reported to be useful in distinguishing GERD from non-GERD. However, measuring BI requires a 24-h testing period, is complicated, and causes considerable patient discomfort.
SUMMARY
Recently, endoscopy-guided catheters that can measure mucosal impedance (MI) and mucosal admittance (MA), which is the inverse of impedance, were developed, and their usefulness in measuring MI and MA for the diagnosis of GERD has been reported. In these studies, esophageal MI values were significantly lower in patients with GERD than in those without GERD. In contrast, esophageal MA was significantly higher in patients with GERD than in those without. Furthermore, we reported that MA is inversely correlated with BI and correlated with acid exposure time. Key Messages: Endoscopy-guided real-time measurement of MI and MA may allow the estimation of mucosal integrity and may be a useful diagnostic tool for patients with GERD in a manner similar to 24-h MII-pH monitoring.
Topics: Catheters; Electric Impedance; Esophageal Mucosa; Esophageal pH Monitoring; Esophagoscopes; Esophagoscopy; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Monitoring, Physiologic; Time Factors
PubMed: 29393167
DOI: 10.1159/000484106 -
Case Reports in Gastroenterology Jan 2014An unusual case of pancreatic arteriovenous malformation (P-AVM) combined with esophageal cancer is reported. A 59-year-old man was admitted with upper abdominal pain....
An unusual case of pancreatic arteriovenous malformation (P-AVM) combined with esophageal cancer is reported. A 59-year-old man was admitted with upper abdominal pain. Contrast-enhanced computed tomography showed numerous strongly enhanced abnormal vessels and a hypovascular lesion in the area of the pancreatic tail. Angiographic study of the celiac artery confirmed racemose vascular networks in the tail of the pancreas. Endoscopic retrograde pancreatography revealed narrowing and displacement of the main pancreatic duct in the tail of the pancreas. Screening esophagoscopy showed a 0-IIa+IIc type tumor in the lower thoracic esophagus. Histological examination of esophagoscopic biopsies showed squamous cell carcinoma. Based on these findings, P-AVM or pancreatic cancer and esophageal cancer were diagnosed. Video-assisted thoracoscopic esophagectomy and distal pancreatectomy were performed. Histological examination of the resected pancreas revealed abundant abnormal vessels with intravascular thrombi. In addition, rupture of a dilated pancreatic duct with pancreatic stones and both severe atrophy and fibrosis of the pancreatic parenchyma were observed. The final diagnoses were P-AVM consequent to severe chronic pancreatitis and esophageal carcinoma. The patient's postoperative course was relatively good.
PubMed: 24574946
DOI: 10.1159/000358193 -
Journal of B.U.ON. : Official Journal... 2017Esophageal cancer is one of the deadliest cancers due to its aggressive behavior and poor survival. It was mentioned in the works of ancient Chinese and Arabo-islamic...
Esophageal cancer is one of the deadliest cancers due to its aggressive behavior and poor survival. It was mentioned in the works of ancient Chinese and Arabo-islamic physicians, centuries before the recognition of high incidence in the Asian esophageal cancer belt. Till the 19th century the disease was considered incurable and the main goal of the proposed treatments was to alleviate dysphagia and pain. The introduction of esophagoscope in 1868 by Adolf Kussmaul (1822-1902) contributed to the observation of the living esophagus and to the diagnosis of esophageal pathologies, paving the way for new therapeutic approaches. In 1877, Vincenz Czerny (1842-1916) performed the first successful resection of the cervical esophagus for carcinoma, followed by Franz Torek (1861-1938) who carried out in 1913 the first successful subtotal thoracic esophagectomy and Tohru Ohsawa (1882-1984) who performed the world's first esophagectomy with an intrathoracic esophagogastric anastomosis. Nowadays, despite the advent of biomedical technology and the development of operation techniques, the surgical treatment of esophagus still remains a challenge.
Topics: Aged; Anastomosis, Surgical; Carcinoma, Squamous Cell; Deglutition Disorders; Esophageal Neoplasms; Esophagectomy; Esophagus; Female; History, 19th Century; History, 20th Century; Humans; Male; Middle Aged
PubMed: 28952239
DOI: No ID Found -
Innovative Surgical Sciences Dec 2016New approaches in the treatment of esophageal cancer comprise endoscopy with refinements of esophagoscopic intraluminal resection by endoscopic submucosal dissection.... (Review)
Review
New approaches in the treatment of esophageal cancer comprise endoscopy with refinements of esophagoscopic intraluminal resection by endoscopic submucosal dissection. Radical open surgery is more and more replaced by minimally invasive esophagectomy (MIO), especially in the hybrid technique with laparoscopic gastrolysis and transthoracic esophageal resection and gastric pull-up. Total MIO also in the robotic technique has not yet shown that it produces superior results than the hybrid technique. Fluorescent dye can improve the intraoperative visualization of the vascularization of the gastric conduit. The individualization of neoadjuvant therapy is the magic word in clinical research of multimodal treatment of esophageal cancer. This means response prediction based on molecular markers or clinical response evaluation. The documentation of the diversity of postoperative complications is now standardized by an international consensus. The value of enhanced recovery after surgery is not yet approved compared to conventional management.
PubMed: 31579724
DOI: 10.1515/iss-2016-0020 -
World Journal of Gastroenterology Mar 2019Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their... (Review)
Review
Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant, minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy (POEM). However, the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
Topics: Diverticulum, Esophageal; Esophagoscopes; Esophagoscopy; Esophagus; Humans; Iatrogenic Disease; Myotomy; Natural Orifice Endoscopic Surgery; Postoperative Complications
PubMed: 30948909
DOI: 10.3748/wjg.v25.i12.1457