-
World Journal of Gastroenterology Apr 2015To compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer. (Meta-Analysis)
Meta-Analysis Review
AIM
To compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer.
METHODS
Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomized controlled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.
RESULTS
Fifteen studies were used, comprising 3203 patients (n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage (RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) associated with LS anastomosis. A significantly reduced rate of anastomotic stricture associated with LS was also found (RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture (P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS (P < 0.00001).
CONCLUSION
This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.
Topics: Anastomosis, Surgical; Anastomotic Leak; Chi-Square Distribution; Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Odds Ratio; Protective Factors; Risk Factors; Stomach; Surgical Stapling; Suture Techniques; Treatment Outcome
PubMed: 25914488
DOI: 10.3748/wjg.v21.i15.4757 -
Thorax Mar 1955
Topics: Disease; Esophageal Diseases; Esophagitis; Esophagus; Humans
PubMed: 14373663
DOI: 10.1136/thx.10.1.56 -
Journal of Applied Physiology... Jan 2020Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and...
Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmHO. In the supine position, the difference amounted to 7.3 ± 2.8 cmHO. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmHO and on the iso-gravitational pleural plane 3.2 ± 1.8 cmHO. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (E) measured by intrathoracic (E = ΔPpl/tidal volume) or esophageal pressure (E = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.
Topics: Aged; Esophagus; Female; Humans; Lung; Lung Compliance; Lung Volume Measurements; Male; Pleural Cavity; Positive-Pressure Respiration; Posture; Pressure; Respiratory Mechanics
PubMed: 31774352
DOI: 10.1152/japplphysiol.00587.2019 -
PloS One 2020Anatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through...
BACKGROUND
Anatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through the oesophagus. This study has two goals 1) to assess feline oesophageal foreign bodies in feline patients using physical, radiologic and endoscopic examination and, how their location influences treatment plans and complications. 2) How the anatomical sharp angle of the oesophagus contribute to foreign body lodgement. Thirty-five cats were enrolled in this study; 30 of them were clinically ill, and five cats were used for anatomical study.
RESULTS
Cats with clinical signs underwent complete clinical and radiologic examination. Endoscopy was performed in only five cases. The site with the highest occurrence of foreign body lodgement was the oesophageal entrance, caudal to the pharynx (63.3%), followed by the thoracic inlet (26.7%) and the mid-cervical region of the oesophagus (10%). Two types of foreign bodies were identified: sewing needles (25/30) and bone (5/30). Radiography was able to identify the location and nature of the foreign body in all 30 affected cats. Therapeutic regimens were applied according to the nature and location of the foreign body and any associated complications. Removal of the foreign body was achieved using Rochester pean artery forceps in 17/30 cases, using full surgical intervention in 8/30 cases, and during endoscopy in 5/30 cases.
CONCLUSION
The results suggest that the location of the foreign body is strongly related to combination of consumed foreign body type and anatomic features of the cat oesophagus. The feline oesophagus has a variety of sharp angles that facilitate the entrapment of rigid linear and angular foreign bodies. Radiographic imaging remains the most frequently used diagnostic modality for determining the lodgement site and nature of radiopaque foreign bodies. Over all complication rate was low (6/30).
Topics: Animals; Cats; Esophagoscopy; Esophagus; Foreign Bodies; Pharynx
PubMed: 32484841
DOI: 10.1371/journal.pone.0233983 -
The Journal of Thoracic and... Feb 2022Type III achalasia outcomes have historically been met with limited success after conventional laparoscopic Heller myotomy (LHM) and pneumatic dilation. Peroral...
BACKGROUND
Type III achalasia outcomes have historically been met with limited success after conventional laparoscopic Heller myotomy (LHM) and pneumatic dilation. Peroral endoscopic myotomy (POEM) has emerged as a promising alterative for a multitude of reasons. Our objective was to investigate POEM outcomes in palliating type III achalasia.
METHODS
A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. The primary outcome was postoperative Eckardt score. We also explored the effect of lower esophageal sphincter (LES) integrated resting pressure (IRP) on manometry, barium column height and width, and complications. Standard statistical methods were applied using R.
RESULTS
A total of 518 patients in the achalasia database were identified, with 308 patients undergoing LHM and 210 undergoing POEM during the study period. POEM was used for type III achalasia in 36 patients (median age, 60 years; 61.7% male), with a median operative time of 85 minutes (interquartile range [IQR], 71-115 minutes) and follow-up of 1 year (IQR, 0.16-2.25 years). Within the POEM group, 11 patients (33%) had previous interventions, including Botox injections to the LES (n = 7), pneumatic dilation (n = 1), and LHM (n = 3). A significant decrease in median Eckardt score was observed (7 preoperatively [IQR, 6-8.75] vs 0 postoperatively [IQR, 0-1]; P < .01). Similar improvements after POEM were noted in median LES IRPs (25.5 mmHg vs 4.5 mmgHg; P < .01), 1-minute barium column height (10 cm vs 0 cm; P < .01), and 1-minute barium column width (2 cm vs 0 cm; P < .01). Patients reported a return to activities of daily living in a median of 7 days (IQR, 3-7 days). Three patients experienced complications, including mucosal perforation resolving with conservative management (n = 1), readmission for bleeding duodenal ulcer responding to proton pump inhibitors (n = 1), and readmission for dysphagia and rehydration (n = 1). Postoperative esophageal pH studies were conducted in 21 patients (62%), demonstrating a Demeester score of >14.72 in 13 patients (62%).
CONCLUSIONS
POEM provides effective and durable palliation for type III achalasia, as demonstrated by symptom relief, esophageal manometry, and radiographic measurement. Considering its low morbidity profile, POEM should be considered as first-line therapy in this challenging disease subtype.
Topics: Aged; Databases, Factual; Deglutition; Esophageal Achalasia; Esophagus; Female; Humans; Male; Middle Aged; Pyloromyotomy; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33741133
DOI: 10.1016/j.jtcvs.2021.01.128 -
Journal of Biomechanics Jul 2022The esophagus is a tubular organ with a multi-laminated tissue structure that functions to transport nutrition from the oral cavity to the stomach. Several diseases of...
The esophagus is a tubular organ with a multi-laminated tissue structure that functions to transport nutrition from the oral cavity to the stomach. Several diseases of the esophagus including congenital disorders require complete surgical esophagectomy. Ideally, segmental removal of the diseased/damaged tissue would spare the unaffected tissue and preserve organ function. To this end, a novel tissue engineered implant, the Cellspan Esophageal Implant (CEI) was used to repair the esophagus following segmental resection of the thoracic esophagus in a porcine model. The current study investigated the mechanical strength and the associated tissue architecture of the CEI-stimulated tissue. The CEI bridged the proximal and distal native esophageal ends to restore the conduit by stimulating a regeneration process that progressed from a fibrovascular scar at 30-days to a fully epithelialized lumen at 90-days, followed by submucosal regeneration and regeneration of a 'laminated' adventitia with smooth muscle development in the 365-day cohort. The mechanical strength of the newly developed tissue as well as the flanking native tissue were assessed using a probe-burst pressure test (ASTM D6797-15). The burst pressures at all three time points were comparable to the native tissue flanking the implant. In addition, the overall pressure required to burst through both the native and regenerated tissues increased with increasing time post-implantation.
Topics: Animals; Biomechanical Phenomena; Esophagectomy; Esophagus; Humans; Regeneration; Swine; Tissue Engineering
PubMed: 35691071
DOI: 10.1016/j.jbiomech.2022.111162 -
African Health Sciences Jun 2022Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications.
BACKGROUND
Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications.
OBJECTIVES
To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures.
METHODS
A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020.
RESULTS
Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hypopharynx and trachea 2(7.1%) each, and cricopharynx 1(3.5%); no FB was found in 3(10.7%) patients. Direct Laryngoscopy was the method of retrieval in 3(10.1%) patients while others had rigid bronchoscopy. Mortality rate was 1.5%.
CONCLUSION
Children are most vulnerable group. Preventive effort should include public health education and close monitoring of children by parents and care givers during play.
Topics: Humans; Child; Foreign Bodies; Bronchi; Bronchoscopy; Esophagus; Esophagoscopy
PubMed: 36407405
DOI: 10.4314/ahs.v22i2.42 -
Scientific Reports Sep 2021We aimed to prepare a bioactive and biodegradable bilayer mesh formed by fibroblast growth factor (FGF) loaded gelatin film layer, and poly ε-caprolactone (PCL) film...
We aimed to prepare a bioactive and biodegradable bilayer mesh formed by fibroblast growth factor (FGF) loaded gelatin film layer, and poly ε-caprolactone (PCL) film layer, and to investigate its treatment efficacy on esophageal anastomosis. It is envisaged that the bioactive mesh in in vivo model would improve tissue healing in rats. The full thickness semicircular defects of 0.5 × 0.5 cm were created in anterior walls of abdominal esophagus. The control group had abdominal esophagus isolated with distal esophageal blunt dissection, and sham group had primary anastomosis. In the test groups, the defects were covered with bilayer polymeric meshes containing FGF (5 μg/2 cm), or not. All rats were sacrificed for histopathology investigation after 7 or 28 days of operation. The groups are coded as FGF(-)-7th day, FGF(+)-7th day, and FGF(+)-28th day, based on their content and operation day. Highest burst pressures were obtained for FGF(+)-7th day, and FGF(+)-28th day groups (p < 0.005) and decreased inflammation grades were observed. Submucosal and muscular collagen deposition scores were markedly increased in these groups compared to sham and FGF(-)-7th day groups having no FGF (p = 0.002, p = 0.001, respectively). It was proved that FGF loaded bioactive bilayer mesh provided effective repair, reinforcement and tissue healing of esophageal defects.
Topics: Anastomosis, Surgical; Animals; Biodegradable Plastics; Esophagus; Fibroblast Growth Factors; Gelatin; Humans; Male; Models, Animal; Polyesters; Rats; Surgical Mesh; Wound Healing
PubMed: 34584186
DOI: 10.1038/s41598-021-98840-w -
The British Journal of Radiology Feb 2018Iatrogenic injury to the oesophagus is a serious complication which is increasingly seen in clinical practice secondary to expansion and greater acceptability of... (Review)
Review
Iatrogenic injury to the oesophagus is a serious complication which is increasingly seen in clinical practice secondary to expansion and greater acceptability of surgical and endoscopic oesophageal procedures. Morbidity and mortality following such injury is high. This is mostly due to an inflammatory response to gastric contents in the mediastinum, and the negative intrathoracic pressures that may further draw out oesophageal contents into the mediastinum leading to mediastinitis. Subsequently, pulmonary complications such as pneumonia or abscess may ensue leading to rapid clinical deterioration. Optimized and timely cross-sectional imaging evaluation is necessary for early and aggressive management of these complications. The goal of this review is to make the radiologist aware of the importance of early and accurate identification of postoperative oesophageal injury using optimized CT imaging protocols and use of oral contrast. Specifically, it is critical to differentiate benign post-operative findings, such as herniated viscus or redundant anastomosis, from clinically significant postoperative complications as this helps guide appropriate management. Advantages and drawbacks of other diagnostic methods, such as contrast oesophagogram, are also discussed.
Topics: Diagnosis, Differential; Esophageal Diseases; Esophagus; Humans; Iatrogenic Disease; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 29166132
DOI: 10.1259/bjr.20170629 -
Medical Physics Jul 2020Automatic segmentation offers many benefits for radiotherapy treatment planning; however, the lack of publicly available benchmark datasets limits the clinical use of...
PURPOSE
Automatic segmentation offers many benefits for radiotherapy treatment planning; however, the lack of publicly available benchmark datasets limits the clinical use of automatic segmentation. In this work, we present a well-curated computed tomography (CT) dataset of high-quality manually drawn contours from patients with thoracic cancer that can be used to evaluate the accuracy of thoracic normal tissue auto-segmentation systems.
ACQUISITION AND VALIDATION METHODS
Computed tomography scans of 60 patients undergoing treatment simulation for thoracic radiotherapy were acquired from three institutions: MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, and the MAASTRO clinic. Each institution provided CT scans from 20 patients, including mean intensity projection four-dimensional CT (4D CT), exhale phase (4D CT), or free-breathing CT scans depending on their clinical practice. All CT scans covered the entire thoracic region with a 50-cm field of view and slice spacing of 1, 2.5, or 3 mm. Manual contours of left/right lungs, esophagus, heart, and spinal cord were retrieved from the clinical treatment plans. These contours were checked for quality and edited if necessary to ensure adherence to RTOG 1106 contouring guidelines.
DATA FORMAT AND USAGE NOTES
The CT images and RTSTRUCT files are available in DICOM format. The regions of interest were named according to the nomenclature recommended by American Association of Physicists in Medicine Task Group 263 as Lung_L, Lung_R, Esophagus, Heart, and SpinalCord. This dataset is available on The Cancer Imaging Archive (funded by the National Cancer Institute) under Lung CT Segmentation Challenge 2017 (http://doi.org/10.7937/K9/TCIA.2017.3r3fvz08).
POTENTIAL APPLICATIONS
This dataset provides CT scans with well-delineated manually drawn contours from patients with thoracic cancer that can be used to evaluate auto-segmentation systems. Additional anatomies could be supplied in the future to enhance the existing library of contours.
Topics: Benchmarking; Four-Dimensional Computed Tomography; Humans; Radiotherapy Planning, Computer-Assisted; Thoracic Neoplasms; Thorax
PubMed: 32128809
DOI: 10.1002/mp.14107