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Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce.Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma.Methods We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (≤1000 µm) and deep submucosal (>1000 µm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low-risk or a high-risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2-mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow-up from histological or PET CT reports when an invasive procedure was not possible.Results In total, 188 superficial oesophageal adenocarcinomas were included with a median follow-up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n= 135) even with high-risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 µm developed lymph node metastasis tumours (n= 10/53; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000-µm threshold for all low-risk tumours (0/25), nor under 1200 µm (0/1) and three over this threshold (3/13, 23.1%).Conclusion Intramucosal and low-risk tumours with shallow submucosal invasion up to 1200 µm were not associated with lymph node metastasis during follow-up. In case of high-risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.

ESD is the reference method to achieve en blocresections for large digestive lesions. Nevertheless, it is a difficult and risky technique. Animal models exist to teach the initial skills, particularly in Japan, where pigs’ stomachs are dedicated models to gastric ESD. In Europe, we have to develop different strategies of teaching with dedicated colon models. A pig colon is a good model but thinner and narrower than a human’s. In this present work, we evaluated a bovine colon model to perform rectal ESD in retroflexion. First, we prepared six bowels to precise the preparation protocol. Then, two endoscopists unexperienced in ESD performed 64 procedures on eight models. Learning curves and factors of variation were studied. A precise protocol to prepare the colon was defined. The two students achieved en blocresection in 89.1 % of cases with a rate of 6.2 % of perforations. A large heterogeneity appeared between the speed and the success rate depending mainly on the age of the animal bowel. Using calf colons, the failure rates were higher (p= 0.002) and the speed was lower (p< 0.001) than for adult bovine ones. A learning curve appeared with, respectively, 0.49 and 0.59 cm2/min throughout the study. No significant difference appeared between measured and calculated specimen areas. Bovine colon is a new model to teach ESD in colorectal conditions. The bovine age is important to homogenize the model. A learning curve existed with a time procedure decreasing throughout the study. Further studies are needed to evaluate the precise learning curve with more students. A bovine colon model is a suitable model to teach colorectal ESD. Nevertheless, an adult bovine colon model is more homogeneous than a calf one.

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Government consultant stays clean in era of contract fraud WASHINGTON--Working as a government contractor can be a frustrating and reputation-threatening job these days. Some defense contractors have come under fire, […]

Several letters to the editor are presented that commend the changes of the journal, its interesting articles and the continued efforts to explore into multimedia articles to provide the readers with informative articles about bicycles and other related products.

Several letters to the editor in response to articles in previous issues including "Real Values," in the December 19, 2005 issue, "Coast Solutions Rolls Out Packaged Services For SMB VARs," in December 13, 2005 issue are presented.