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Background: Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care. Methods: For the years 2000–2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality. Results: Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC. Conclusion: The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients. [ABSTRACT FROM AUTHOR]

This article reports an innovative and unprecedented use of Holmium: YAG laser in the extraction of a foreign body impacted in the upper oesophagus without complications. Hence, Holmium-YAG laser can be a safe, efficient and successful aid to fragment the impacted foreign bodies to assist in their removal. [ABSTRACT FROM AUTHOR]

Background: Whether Peroral Endoscopic Myotomy (POEM) can be proposed as a second-line treatment in patients with achalasia remains to be confirmed in real-life series. Objective: This study aimed to compare the efficacy, feasibility and safety of POEM between treatment-naïve patients and patients who had prior endoscopic or surgical therapies for achalasia. Methods: All consecutive patients who underwent a POEM procedure for achalasia in our centre from June 2015 to September 2018 were included in this retrospective study. They were classified into treatment-naïve patients (POEM1) and patients who had at least one previous endoscopic and/or surgical treatment for achalasia (POEM2). Results: A total of 105 patients were included, 52 in the POEM1 group and 53 in the POEM2 group. Clinical success (defined as an Eckardt score ≤ 3) at 6 months was observed in 93% of POEM1 patients and 84% of POEM2 patients (p = 0.18). Technical success rate was not significantly different between the two groups (100% vs 96%, respectively; p = 0.50). No significant difference was noted in terms of adverse event rate (19% vs 19%, respectively; p = 1.00). Post-procedure pain occurred in 12% of treatment-naive and 9% of non-naïve patients (p = 0.76). The median length of hospital stay was 3 days in both groups (p = 0.17). Symptomatic gastroesophageal reflux occurred in 25% of POEM1 patients and 16% of POEM2 patients (p = 0.24). Conclusion: Efficacy, feasibility and safety of POEM are not different between treatment-naïve and non-naïve patients. POEM is a valuable second-line approach in patients with persistent symptoms of achalasia after surgical or endoscopic treatments. [ABSTRACT FROM AUTHOR]

To analyse the patients with foreign body oesophagus in relation to the clinico-radiological and socio-economic profile. The present prospective study was conducted on 100 consecutive patients of all age groups who underwent oesophagoscopy for suspected foreign body ingestion in a tertiary care hospital. The most common age group affected was 0–5 years. The median age was 5 ± 14.37 years. There was preponderance in males as compared to females, male to female ratio was 2.23:1. Majority (70%) of the patients, both males and females, belonged to rural areas. Lower socio-economic group was more commonly affected (54%). The most commonly reported symptom was foreign body sensation (55%) followed by vomiting (54%) and difficulty in swallowing (51%). Foreign body ingestion was witnessed in only 19% cases by the family members. The mean time between ingestion of the foreign body and admission to the hospital was found to be 4.5 h. The majority (97%) of foreign bodies were radio-opaque. The most common site of lodgement was just below the cricopharynx (89%). The most common foreign body retrieved in our series were coins (65%). The majority of foreign bodies (68%) were retrieved in 20–40 min after induction of general anaesthesia. In 99% of the patients we did not encounter any complications. The majority (93%) of the patient's parents/relatives had curiosity to have a glimpse of the foreign body till they actually saw the retrieved foreign body. Foreign body lodgement is more common among children of lower socio-economic strata more so in rural areas. Rigid oesophagoscopy is a safe and effective procedure for removal of the foreign body. Early intervention makes it easier to extract the foreign body without complications. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence of synchronous oesophageal cancer in patients with head and neck cancers using Narrow Band Imaging and Lugol’s chromoendoscopy.Study design: Prospective cross sectional diagnostic study. Method: 63 recruited patients with head and neck cancers, underwent haematologic evaluation, histological confirmation, imaging which included contrast enhanced computerised tomography(CECT) of the Neck and when indicated an additional Magnetic Resonance Imaging(MRI) scan followed by UGI endoscopy using white light followed by Narrow Band Imaging(NBI) and Lugol’s chromoendoscopy(LCE).Oesophageal examination picked up a gastric inlet patch in 5 subjects and epithelial hyperplasia in one while the remaining 57 were normal on using White Light Endoscopy (WLE). NBI identified an abnormal pattern in 4 patients in whom WLE was normal (3 – Type II Intra Papillary Capillary Loop (IPCL) pattern, 1- Type III IPCL pattern). LCE showed unstained mucosa of < 10 mm in six patients, the histopathology reported were normal tissue in two patients, mild chronic oesophagitis in two and, gastric metaplasia and high grade dysplasia in one each respectively. Unstained mucosa of > 10 mm in one subject showed epithelial hyperplasia. Two patients had an abnormal NBI and LCE pattern although the WLE were normal.By utilizing NBI and LCE, although oesophageal cancer was not detected, premalignant pathology like high grade dysplasia, as well as gastric metaplasia, epithelial hyperplasia, esophagitis were detected. Using both NBI and LCE along with WLE would be complimentary to detect early pathological lesions. Capturing the lesions in the window period that exists between the transformation of epithelial dysplasia to carcinoma and treating them early will reduce the morbidity and also improve the outcome in oesophageal malignancy.Materials and methods: To study the prevalence of synchronous oesophageal cancer in patients with head and neck cancers using Narrow Band Imaging and Lugol’s chromoendoscopy.Study design: Prospective cross sectional diagnostic study. Method: 63 recruited patients with head and neck cancers, underwent haematologic evaluation, histological confirmation, imaging which included contrast enhanced computerised tomography(CECT) of the Neck and when indicated an additional Magnetic Resonance Imaging(MRI) scan followed by UGI endoscopy using white light followed by Narrow Band Imaging(NBI) and Lugol’s chromoendoscopy(LCE).Oesophageal examination picked up a gastric inlet patch in 5 subjects and epithelial hyperplasia in one while the remaining 57 were normal on using White Light Endoscopy (WLE). NBI identified an abnormal pattern in 4 patients in whom WLE was normal (3 – Type II Intra Papillary Capillary Loop (IPCL) pattern, 1- Type III IPCL pattern). LCE showed unstained mucosa of < 10 mm in six patients, the histopathology reported were normal tissue in two patients, mild chronic oesophagitis in two and, gastric metaplasia and high grade dysplasia in one each respectively. Unstained mucosa of > 10 mm in one subject showed epithelial hyperplasia. Two patients had an abnormal NBI and LCE pattern although the WLE were normal.By utilizing NBI and LCE, although oesophageal cancer was not detected, premalignant pathology like high grade dysplasia, as well as gastric metaplasia, epithelial hyperplasia, esophagitis were detected. Using both NBI and LCE along with WLE would be complimentary to detect early pathological lesions. Capturing the lesions in the window period that exists between the transformation of epithelial dysplasia to carcinoma and treating them early will reduce the morbidity and also improve the outcome in oesophageal malignancy.Results: To study the prevalence of synchronous oesophageal cancer in patients with head and neck cancers using Narrow Band Imaging and Lugol’s chromoendoscopy.Study design: Prospective cross sectional diagnostic study. Method: 63 recruited patients with head and neck cancers, underwent haematologic evaluation, histological confirmation, imaging which included contrast enhanced computerised tomography(CECT) of the Neck and when indicated an additional Magnetic Resonance Imaging(MRI) scan followed by UGI endoscopy using white light followed by Narrow Band Imaging(NBI) and Lugol’s chromoendoscopy(LCE).Oesophageal examination picked up a gastric inlet patch in 5 subjects and epithelial hyperplasia in one while the remaining 57 were normal on using White Light Endoscopy (WLE). NBI identified an abnormal pattern in 4 patients in whom WLE was normal (3 – Type II Intra Papillary Capillary Loop (IPCL) pattern, 1- Type III IPCL pattern). LCE showed unstained mucosa of < 10 mm in six patients, the histopathology reported were normal tissue in two patients, mild chronic oesophagitis in two and, gastric metaplasia and high grade dysplasia in one each respectively. Unstained mucosa of > 10 mm in one subject showed epithelial hyperplasia. Two patients had an abnormal NBI and LCE pattern although the WLE were normal.By utilizing NBI and LCE, although oesophageal cancer was not detected, premalignant pathology like high grade dysplasia, as well as gastric metaplasia, epithelial hyperplasia, esophagitis were detected. Using both NBI and LCE along with WLE would be complimentary to detect early pathological lesions. Capturing the lesions in the window period that exists between the transformation of epithelial dysplasia to carcinoma and treating them early will reduce the morbidity and also improve the outcome in oesophageal malignancy.Conclusion: To study the prevalence of synchronous oesophageal cancer in patients with head and neck cancers using Narrow Band Imaging and Lugol’s chromoendoscopy.Study design: Prospective cross sectional diagnostic study. Method: 63 recruited patients with head and neck cancers, underwent haematologic evaluation, histological confirmation, imaging which included contrast enhanced computerised tomography(CECT) of the Neck and when indicated an additional Magnetic Resonance Imaging(MRI) scan followed by UGI endoscopy using white light followed by Narrow Band Imaging(NBI) and Lugol’s chromoendoscopy(LCE).Oesophageal examination picked up a gastric inlet patch in 5 subjects and epithelial hyperplasia in one while the remaining 57 were normal on using White Light Endoscopy (WLE). NBI identified an abnormal pattern in 4 patients in whom WLE was normal (3 – Type II Intra Papillary Capillary Loop (IPCL) pattern, 1- Type III IPCL pattern). LCE showed unstained mucosa of < 10 mm in six patients, the histopathology reported were normal tissue in two patients, mild chronic oesophagitis in two and, gastric metaplasia and high grade dysplasia in one each respectively. Unstained mucosa of > 10 mm in one subject showed epithelial hyperplasia. Two patients had an abnormal NBI and LCE pattern although the WLE were normal.By utilizing NBI and LCE, although oesophageal cancer was not detected, premalignant pathology like high grade dysplasia, as well as gastric metaplasia, epithelial hyperplasia, esophagitis were detected. Using both NBI and LCE along with WLE would be complimentary to detect early pathological lesions. Capturing the lesions in the window period that exists between the transformation of epithelial dysplasia to carcinoma and treating them early will reduce the morbidity and also improve the outcome in oesophageal malignancy. [ABSTRACT FROM AUTHOR]

Background: Foreign body ingestion involving the paediatric age group is a common emergency referral encountered by Otorhinolaryngologists. The cervical oesophagus has been noted as the most prevalent site of impaction. Traditionally, a rigid oesophagoscopy would be required for examination under anaesthesia and removal of the foreign body is found, but this method may miss foreign bodies that are embedded into the mucosa, and faulty technique may result in perforation of the esophagus. Method and results: We present a suspension microesophagoscopy technique using a Lindholm laryngoscope and suspension to retract and suspend the opening of the oesophagus. Conclusion: This technique not only gives the surgeon an advantage to perform a two-handed procedure but also allows for a magnified examination of the oesophageal mucosa with the help of a rigid telescope for a thorough examination. Bullet Point summary.: The best diagnostic and therapeutic method for the management of foreign body in the oesophagus is examination under anaesthesia. Suspension microesophagoscopy can be done in the operation theatre with pre-existing instrument. This technique allows freedom for a two-handed technique. This technique gives a magnified visualisation of the mucosa revealing any embedded foreign body. [ABSTRACT FROM AUTHOR]

Oesophageal strictures in cats and dogs are relatively rare and the cause of this disorder can be multifactorial. However, the most common cause in cats is an inflammatory process. Conservative treatment strategies for this disorder includes image-guided interventions. Endoscopic methods are a form of a minimally invasive surgical treatment of the oesophageal strictures. Several endoscopic methods for the therapy of this condition are known, one of them is Savary-Gilliard dilators technique. In the present study of a case of oesophageal stricture in a cat, caused probably by doxycycline treatment without water administration, the authors used the Savary-Gilliard dilators as a therapy for its condition. The animal underwent 3 endoscopy procedures, where in the third one no abnormality in the oesophagus was observed. Moreover, the cat was asymptomatic 6 months after the last oesophagoscopy. In the authors opinion, based on the present case, some experience of the authors and previously described studies, the Savary-Gilliard dilators seems to be a safe, effective, relatively cheap and minimally invasive method of the oesophageal stricture therapy in the cat. [ABSTRACT FROM AUTHOR]

Oesophageal tuberculosis, an uncommon form of extrapulmonary tuberculosis, has been reported mainly as small case series and the literature is heterogeneous. A systematic review to characterize the clinical presentation, evaluation and management of oesophageal tuberculosis was performed. Electronic databases were searched with keywords: esophagus OR esophageal AND tuberculosis. We included original papers and case series (> 4 patients) with oesophageal tuberculosis. Twenty-two studies reporting 311 patients were included. Mean age in most of the studies was 31–51 years and male gender constituted 50.5% patients. Dysphagia (72.3%), odynophagia (22.4%) and chest pain (31.3%) were predominant symptoms. Mid-oesophagus was the commonest site of involvement (88%). Endoscopic findings included ulcers (59.9%), submucosal bulge (31.7%), extrinsic compression (24.8%) and pseudotumour (5.8%). On endoscopic ultrasound, presence of hypoechoic (69.5%), heteroechoic (47.6%) and matted (86.3%) mediastinal lymph nodes and oesophageal wall involvement (67.3%) were common findings. Computed tomography showed mediastinal lymphadenopathy (76.5%) and oesophageal thickening (52.1%). Diagnosis was confirmed by granuloma (72.3%) and acid fast bacilli positivity (32.5%) in mots patients. Response to antitubercular therapy was excellent; 97.7% patients recovered and 2.3% patients died. Surgery (14.5%) and oesophageal stenting (11.4%) were required infrequently. Oesophageal tuberculosis should be considered in endemic regions as a cause of dysphagia because early treatment is associated with excellent outcomes. [ABSTRACT FROM AUTHOR]

Oesophageal denture impactions may have varying presentations ranging from dysphagia to a complex tracheo-oesophageal fistula (TOF). Endoscopic removal of the denture may be unsuccessful due to the sharp-edged nature of the denture with metal appendages and delayed presentation. In such instances, surgical treatment may be the safer option. We aim to study the different presentations of impacted dentures in the oesophagus requiring operative intervention and the best surgical approach in these patients. This is a case series analysis of our experience in the surgical management of patients with impacted oesophageal dentures, presenting to our Upper Gastrointestinal Surgical Unit, over a 10-year period from 2009 to 2019. A total of 15 patients (M: F—8:7) with ages ranging from 25 to 67 years underwent surgical removal of impacted dentures during the time period. Dysphagia was the commonest presenting symptom, and the site of impaction was equally common in both cervical and thoracic oesophagus. Cervical impactions were managed by a neck exploration and the thoracic impactions necessitated an open or minimally invasive transthoracic extraction. Three patients with thoracic impactions presented late with tracheo-oesophageal fistula formation. A novel technique (neo-membranous oesophageal patch—NMOP) was used in the management of TOF in these patients. Surgical management of impacted oesophageal dentures is required in cases of failed endoscopic retrieval. The surgical management should involve an algorithmic approach based on the site of impaction, associated local sepsis, and the presence or absence of a fistula. Tracheo-oesophageal fistula is a rare complication of impacted dentures and we have successfully used a novel technique (NMOP) for the management of this difficult problem. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate management pathways, outcomes and safety of rigid endoscopy (RE) and flexible endoscopy (FE) for the treatment of impacted foreign bodies of the upper gastrointestinal tract (UGIT) in adults. Methods: Retrospective study, included all patients undergoing RE or FE for impacted UGIT foreign body over an 11-year-period. Results: A total of 144 patients were included (95 FE and 49 RE). FE were performed under local anaesthetic or sedation, and RE under GA. Success rate of FE and RE were 95.8% and 95.9% respectively. During FE an intra-procedural biopsy was performed in 45/95 (47.3%); with 26/95(27.4%) identifying mucosal pathology. Complications was significantly higher in patients having RE (40.8% versus 6.3%, p =.001). Conclusion: FE and RE are effective for the therapeutic management of impacted UGIT foreign bodies. However, FE can be performed under LA and was associated with fewer complications, favouring FE where possible as a first line option. [ABSTRACT FROM AUTHOR]

Oesophageal cancer is a virulent malignancy and continues to represent a formidable challenge for both patients and clinicians. Surgical resection remains the most definitive form of treatment whether performed alone or in combination with chemotherapy and radiation therapy as part of a multimodality treatment strategy. There are several controversies in the surgical management of oesophageal cancer including the surgical approach, extent of resection, optimal fields of lymph node dissection, and the ideal location of anastomosis. Multiple approaches have been described for esophagectomy, which can be thematically grouped under two major categories: either transthoracic or transhiatal. The main controversy rests on whether a more extended resection through thoracotomy provides superior oncological outcomes as opposed to resection with relatively limited morbidity and mortality through a transhiatal approach. After numerous trials that have addressed these issues, neither approach has consistently proven to be superior to the other one, and both can provide excellent short-term results in the hands of experienced surgeons. At present, the trend is towards minimally invasive surgery in search of a better outcome as well as quality of life. [ABSTRACT FROM AUTHOR]

Oesophageal balloon calibration improves the oesophageal pressure (Pes) assessment during invasive controlled mechanical ventilation. The primary aim of the present investigation was to ascertain the feasibility of oesophageal balloon calibration during pressure support ventilation (PSV). Secondarily, the calibrated Pes (Pescal) was compared to uncalibrated one acquired at 4 ml-filling volume (PesV4), as per manufacturer recommendation. After a naso-gastric tube equipped with oesophageal balloon was correctly positioned in 21 adult patients undergoing invasive volume-controlled ventilation (VCV) for acute hypoxemic respiratory failure, the balloon was progressively inflated, applying a series of end-inspiratory and end-expiratory holds at each filling volume during VCV and PSV. Upon optimal balloon filling volume (Vbest) was identified, Pescal was computed by correcting the Pes measured at Vbest for the oesophageal wall pressure elicited at same filling volume. Finally, end-expiratory and end-inspiratory PesV4 were recorded too. A total of 42 calibrations, 21 per ventilatory mode, were performed. Vbest was 1.9 ± 1.6 ml in VCV and 1.7 ± 1.6 ml in PSV (p = 0.5217). PesV4 was overestimated compared to Pescal at end-expiration and end-inspiration (p <0.0001 for all comparisons) in both VCV (13.4 ± 3.4 cmH2O and 15.4 ± 3 cmH2O vs. 8.5 ± 2.9 cmH2O and 11.4 ± 3 cmH2O) and PSV (14.7 ± 4.2 cmH2O and 17 ± 3.9 cmH2O vs. 8.9 ± 3.4 cmH2O and 12.4 ± 3.9 cmH2O). In PSV, oesophageal balloon calibration is feasible and allows to obtain a reliable Pes assessment compared to uncalibrated approach. [ABSTRACT FROM AUTHOR]

Objectives: To determine association of gross tumour volume (GTV) of resectable oesophageal squamous cell carcinoma (SCC) measured on T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI) and diffusion-weighted imaging (DWI) with T category and lymphatic metastasis (LM).Methods: Sixty oesophageal SCC patients underwent fat-suppressed T2WI, CE-T1WI and DWI with b values of 0, 500 and 800 s/mm2. GTV was measured on three sequences. Statistical analyses were performed to determine association of GTV with T category and LM.Results: Spearman's rank correlation analysis showed positive association of GTV with T category and LM (all p values < 0.01). Differences in GTV were found between T1 and T2 or T3 categories shown by Kruskal-Wallis H and one-way ANOVA tests, and between T1/T2 and T3 and between tumours with and without LM by Mann-Whitney U tests (all p values < 0.05). Receiver operating characteristic analyses showed cut-off GTVs of 5.795, 5.276 and 10.11 cm3 on CE-T1WI could better differentiate T1 from T2 categories, T1 from T3, and T1-2 from T3 than those of 7.066, 7.045 and 8.504 cm3 on T2WI, of 5.793, 6.609 and 6.989 cm3 on DWI with b value of 500 s/mm2, and of 4.156, 4.519 and 4.985 cm3 with b value of 800 s/mm2, respectively. Cut-off of 10.462 cm3 on DWI with b value of 500 s/mm2 could better identify LM than of 12.38, 8.793 and 9.600 cm3 on T2WI, CE-T1WI and DWI with b value of 800 s/mm2, respectively.Conclusions: GTVs on T2WI, CE-T1WI and DWI are associated with T category of and LM of oesophageal SCC.Key Points: • GTV is associated with T category and lymphatic metastasis of oesophageal SCC • GTV measured on contrast-enhanced T 1 -weighted imaging better identifies T category • GTV measured on DWI with b value of 500 s/mm 2 better identifies lymphatic metastasis. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical surgery in patients with advanced adenocarcinoma (AC) of the oesophagus.Patients and Methods: Between 2005 and 2015, a total of 102 consecutive patients with a median age of 64 years (range, 44-86 years) and AC of the oesophagus were evaluated of whom 84 received a full CRT. A group of 51 patients was treated with neoadjuvant intent followed by radical surgery. A total dose of 50.4 Gy with mostly weekly paclitaxel/fluorouracil chemotherapy was administered. Six to eight weeks following CRT, a transthoracic subtotal oesophageal and proximal gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary endpoints) were calculated according to Kaplan-Meier, and possible prognostic factors were evaluated by the log-rank test as well as by a Cox regression analysis.Results: Median follow-up time of the surviving patients was 48 months (range, 14-134 months). Overall and NED survival rates for patients of the study group (n = 51) were 40 and 32%, respectively, at 5 years. Age (p = 0.04), ypT category (p = 0.1) and the development of distant metastases (p = 0.05) were identified as (marginally) independent prognostic variables with impact on survival. Median survival time for patients of the study group (n = 51) was 45 ± 18 months (95%CI 9-81 months). Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual cancer and increased number of residual cells, but predominantly fibrosis were 33, 41, and 10%, respectively. Patterns of failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases in 27/51 (53%) patients.Conclusion: Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is a locally very effective concept. A significant tumour regression in almost 75% of the patients may stimulate prospective trials on the omission of radical surgery for some elderly patients. Due to a high rate of distant metastases further investigations in terms of effective systemic therapy may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective cohort study developed a prognostic model incorporating PET texture analysis in patients with oesophageal cancer (OC). Internal validation of the model was performed.Methods: Consecutive OC patients (n = 403) were chronologically separated into development (n = 302, September 2010-September 2014, median age = 67.0, males = 227, adenocarcinomas = 237) and validation cohorts (n = 101, September 2014-July 2015, median age = 69.0, males = 78, adenocarcinomas = 79). Texture metrics were obtained using a machine-learning algorithm for automatic PET segmentation. A Cox regression model including age, radiological stage, treatment and 16 texture metrics was developed. Patients were stratified into quartiles according to a prognostic score derived from the model. A p-value < 0.05 was considered statistically significant. Primary outcome was overall survival (OS).Results: Six variables were significantly and independently associated with OS: age [HR =1.02 (95% CI 1.01-1.04), p < 0.001], radiological stage [1.49 (1.20-1.84), p < 0.001], treatment [0.34 (0.24-0.47), p < 0.001], log(TLG) [5.74 (1.44-22.83), p = 0.013], log(Histogram Energy) [0.27 (0.10-0.74), p = 0.011] and Histogram Kurtosis [1.22 (1.04-1.44), p = 0.017]. The prognostic score demonstrated significant differences in OS between quartiles in both the development (X2 143.14, df 3, p < 0.001) and validation cohorts (X2 20.621, df 3, p < 0.001).Conclusions: This prognostic model can risk stratify patients and demonstrates the additional benefit of PET texture analysis in OC staging.Key Points: • PET texture analysis adds prognostic value to oesophageal cancer staging. • Texture metrics are independently and significantly associated with overall survival. • A prognostic model including texture analysis can help risk stratify patients. [ABSTRACT FROM AUTHOR]

Background: Recent studies showed that stent grafting is a promising technique for treatment of esophageal perforation. However, the evidence of its benefits is still scarce.Methods: Forty-three consecutive patients underwent stent grafting for esophageal perforation at the Oulu University Hospital, Finland. The main endpoints of this study were early and mid-term mortality. Secondary outcome endpoints were the need of esophagectomy and additional surgical procedures on the esophagus and extraesophageal structures.Results: Patients' mean age was 64.6 ± 13.4 years. The mean delay to primary treatment was 23 ± 27 h. The most frequent cause of perforation was Boerhaave's syndrome (46.5%). The thoraco-abdominal segment of the esophagus was affected in 58.1% of cases. Minor primary procedures were performed in 25 patients (58.1%) and repeat surgical procedures in 23 patients (53.5%). Forty-nine repeat stent graftings were performed in 22 patients (50%). Two patients (4.7%) underwent esophagectomy, one for unrelenting preprocedural stricture of the esophagus and another for persistent leakage of a perforated esophageal carcinoma. The mean length of stay in the intensive care unit was 6.0 ± 7.5 days and the in-hospital stay was 24.3 ± 19.6 days. In-hospital mortality was 4.6%. Three-year survival was 67.2%.Conclusions: Stent grafting seems to be an effective less invasive technique for the treatment of esophageal perforation. Repeat stent grafting and procedures on the pleural spaces are often needed to control the site of perforation and for debridement of surrounding infected structures. Stent grafting allows the preservation of the esophagus in most of patients. The mid-term survival of these patients is suboptimal and requires further investigation. [ABSTRACT FROM AUTHOR]

Non-malignant oesophageal diseases are critical to recognize, but can be easily overlooked or misdiagnosed radiologically. In this paper, we cover the salient clinical features and imaging findings of non-malignant pathology of the oesophagus. We organize the many non-malignant diseases of the oesophagus into two major categories: luminal disorders and wall disorders. Luminal disorders include dilatation/narrowing (e.g. achalasia, scleroderma, and stricture) and foreign body impaction. Wall disorders include wall thickening (e.g. oesophagitis, benign neoplasms, oesophageal varices, and intramural hematoma), wall thinning/outpouching (e.g. epiphrenic diverticulum, Zenker diverticulum, and Killian-Jamieson diverticulum), wall rupture (e.g. iatrogenic perforation, Boerhaave Syndrome, and Mallory-Weiss Syndrome), and fistula formation (e.g. pericardioesophageal fistula, tracheoesophageal fistula, and aortoesophageal fistula). It is the role of the radiologist to recognize the classic imaging patterns of these non-malignant oesophageal diseases to facilitate the delivery of appropriate and prompt medical treatment. Teaching Points : • Nonmalignant oesophageal disease can be categorised by the imaging appearance of wall and lumen. • Scleroderma and achalasia both cause lumen dilatation via different pathophysiologic pathways. • Oesophageal wall thickening can be inflammatory, neoplastic, traumatic, or vascular in aetiology. [ABSTRACT FROM AUTHOR]

Objectives: Determine the feasibility of and tissue response to biodegradable magnesium-silicone stent insertion into the oesophagus of rabbits.Methods: Mechanical compression-recovery and degradation behaviours of the stents were investigated in vitro. Thirty rabbits were randomly divided into a magnesium-silicone stent group (n = 15) that received stent insertion into the lower 1/3 of the oesophagus under fluoroscopic guidance and a control group (n = 15). Oesophagography was performed at 1, 2 and 4 weeks. Five rabbits in each group were euthanized at each time point for histological examination.Results: Magnesium-silicone stents showed good flexibility and elasticity, and degraded more slowly than bare stents at pH 4.0 and 7.4. All stent insertions were well tolerated. The oesophageal diameters at 1, 2 and 4 weeks were 9.7 ± 0.7, 9.6 ± 0.8 and 9.6 ± 0.5 mm, respectively (vs. 9.2 ± 0.8 mm before intervention; P > 0.05). Stent migration occurred in six rabbits (one at 1 week, one at 2 and four at 4). Microscopy demonstrated dilation of the oesophageal wall within 1 week of insertion. Oesophageal injury and collagen deposition following stent insertion were similar to control (P > 0.05).Conclusions: Oesophageal magnesium-silicone stent insertion was feasible and provided reliable support for 2 weeks without causing oesophageal injury or collagen deposition.Key Points: • Mg stent provided apparently adequate radial force and silicone membrane reduced magnesium biodegradation • Stent insertion provided good support for at least 2 weeks before biodegradation • Stenting effectively resulted in oesophageal wall remodelling, without demonstrable injury. [ABSTRACT FROM AUTHOR]

Allergy testing has been advocated for patients with eosinophilic esophagitis (EoE) as a means of defining food triggers and directing dietary therapy. Several recent and comprehensive studies have demonstrated the futility of skin prick (SPT), skin patch (APT) and serum food antigen specific IgE (SIgE) estimates in this context. Furthermore, if identification of food triggers is the endpoint (as opposed to the ability of an allergy test-directed diet merely to induce remission), previous positive studies have limitations. Evolving evidence that EoE may be a non-IgE-mediated disease has led to trials of new assays including serum IgG to food allergens, the cytokine thymic stromal lymphopoietin (TSLP) and basophil activation, all without success. Rather than using allergy test-directed diets, the clinician should use empirical elimination diets which are practical, and consider minimally invasive sampling of the oesophagus to facilitate dietary reintroduction. Research should be redoubled to consider not only assays to predict food triggers but also those that monitor disease activity. The anti-inflammatory effect of proton pump inhibitors and deficits in barrier integrity may influence the success of dietary therapy and the results of allergy tests and should be considered in future research design. [ABSTRACT FROM AUTHOR]

Survival outcomes following multimodal treatment of operable oesophageal and gastrooesophageal cancer remain disappointingly poor. Although an appreciation of the impact of both tumour location and histological subtype is now shaping the design of clinical trials, there has been a lack of consensus of the optimal neoadjuvant treatment strategy. This update article will review recent advances in the use of both neoadjuvant chemotherapy and chemoradiotherapy. The emerging role of PET imaging to direct appropriate neoadjuvant treatment regimens and the additive benefit of biological agents are also discussed. [ABSTRACT FROM AUTHOR]

Purpose: Gut microbiota is predicted to play a key role in manifestation of gastrointestinal tract cancers. The human gastrointestinal tract is a complex and abundant network of microbial community. Gut microbiota depicts the microbe population living in our intestine. Humans harbour more than 10 microbes in the gut, and the diversity and densities of the microbiota increase from stomach to colon. Methods: The beneficial relationship between endogenous microbiota and the eukaryotic hosts helps in maintaining various metabolic activities of the body as well as temperature and pH balance. Studies using culturing methods have suggested that the oesophagus is either sterile or contains only a few transient microbes that originates from the oropharynx by swallowing or from the stomach by gastroesophageal reflux. However, metagenomics suggest that large numbers of uncultured organisms are harboured in the human gut. Results: Observations suggest that research directed towards manipulation of the gut microbiota can be employed in prevention as well as treatment of these conditions. Well-designed, randomized, placebo-controlled human studies using probiotics and/or prebiotics are necessary to formulate the directions for prevention and therapy. Conclusions: Change in gut microbes in gastrointestinal (GI) tract may have major implication in gastric cancer, the fifth most occurring malignancy in the world. Affected population manifests multiple conditions and diseases, which majorly includes inflammatory bowel disease and colorectal malignancy. [ABSTRACT FROM AUTHOR]

Purpose: This project sought to test the role of diet-related inflammation in modulating the risk of oesophageal cancer. Methods: A nationwide population-based case-control study was conducted from 1 December 1994 through 31 December 1997 in Sweden. All newly diagnosed patients with adenocarcinoma of the oesophagus or gastroesophageal junction and a randomly selected half of patients with oesophageal squamous cell carcinoma were eligible as cases. Using the Swedish Registry of the Total Population, the control group was randomly selected from the entire Swedish population and frequency-matched on age (within 10 years) and sex. The literature-derived dietary inflammatory index (DII) was developed to describe the inflammatory potential of diet. DII scores were computed based on a food frequency questionnaire. Higher DII scores indicate more pro-inflammatory diets. Odds ratios and 95 % confidence intervals (CI) were computed to assess risk associated between DII scores and oesophageal cancer using logistic regression adjusted by potential confounders. Results: In total, 189 oesophageal adenocarcinomas, 262 gastroesophageal junctional adenocarcinomas, 167 oesophageal squamous cell carcinomas, and 820 control subjects were recruited into the study. Significant associations with DII were observed for oesophageal squamous cell carcinoma (OR 4.35, 95 % CI 2.24, 8.43), oesophageal adenocarcinoma (OR 3.59, 95 % CI 1.87, 6.89), and gastroesophageal junctional adenocarcinoma (OR 2.04, 95 % CI 1.24, 3.36). Significant trends across quartiles of DII were observed for all subtypes of oesophageal cancer. Conclusions: Diet-related inflammation appears to be associated with an increased risk of oesophageal cancer, regardless of histological type. [ABSTRACT FROM AUTHOR]

Background: Tracheo-oesophageal malformations result from disturbed foregut separation during early development. The notochord, a specialised embryonic structure, forms immediately adjacent to the dividing foregut. In the Adriamycin mouse model of oesophageal atresia, foregut and notochord abnormalities co-exist, and the site and severity of foregut malformations closely correlate to the position and extent of the notochord defects. Notochord and foregut abnormalities also co-exist in the Noggin Knockout mouse as well in a small number of human cases. The notochord is a source of powerful molecular signals during early embryogenesis, being particularly important for neural crest development. The influence of notochord signaling on the adjacent foregut is not known. The purpose of this study was to examine the impact of notochord manipulation on foregut separation using a robust 3D explant method for culturing isolated foregut which permits oeosphageal and tracheal formation in vitro.Methods: Foregut was micro-dissected from embryonic day 9 mice (License B100/4447 Irish Medicines Board), embedded in collagen and cultured for 48 h with native notochord intact (n = 6), notochord removed (n = 10) or additional notochord transplanted from stage matched controls (n = 8). Specimens were analysed for foregut morphology and molecular patterning using immunohistochemistry for Hnf3b (an endoderm marker) and Sox2 (a notochord and oesophageal marker) on cryosections.Results: Foregut separation into distinct oesophagus and trachea was observed in isolated foregut specimens with or without their native notochord. In specimens with additional notochord transplants, foregut morphology and molecular patterning were comparable to controls whether or not the native notochord was maintained. In particular foregut separation was not disrupted by the transplantation of additional notochord at the dorsal foregut endoderm.Conclusion: The relationship between the embryonic foregut and notochord is complex and ill-defined; however, the notochord does not contribute essentially to oesophagus and trachea formation beyond E9 in the mouse, and the transplantation of additional notochord does not disrupt foregut separation in 3D explant culture. [ABSTRACT FROM AUTHOR]

Purpose: A retrospective analysis of oesophageal thickening diagnosed as an incidental finding at Computed Tomography (CT) with endoscopic and histological correlation. Materials and methods: Retrospective review of CT studies at a University Teaching Hospital in a 3-month period was performed and those who had a correlating upper gastrointestinal endoscopy within 6 months of the CT were included in the study. The findings were correlated with results from endoscopy to histology. The CT images were reviewed by two Consultant Radiologists with a sub-speciality interest in Abdominal Imaging prior to correlation with endoscopic and histology results from the patient's medical records. Results: Three hundred and sixty-one patients met the inclusion, of which 20 % ( n = 72) were felt to have a thickened distal oesophagus on CT. Of these, 30.6 % ( n = 22) had a mass or abnormal mucosal thickening on endoscopy, found to be malignant on subsequent biopsy in 50 % ( n = 11) and Barrett's epithelium in 50 % ( n = 11), a statistically significant finding compared to those who had a normal CT. Conclusion: Endoscopic evaluation is recommended for incidental oesophageal thickening detected at Computed Tomography to exclude underlying malignancy. [ABSTRACT FROM AUTHOR]

Background: During thoracoscopic oesophageal surgery, we observed not previously described fascia-like structures. Description of similar structures in rectal cancer surgery was of paramount importance in improving the quality of resection. Therefore, we aimed to describe a new comprehensive concept of the surgical anatomy of the thoracic oesophagus with definition of the meso-oesophagus. Methods: We retrospectively evaluated 35 consecutive unedited videos of thoracoscopic oesophageal resections for cancer, to determine the surgical anatomy of the oesophageal fascia's vessels and lymphatic drainage. The resulting concept was validated in a prospective study, including 20 patients at three different centres. Additional confirmation was sought by a histologic study of a cadaver's thorax. Results: A thin layer of connective tissue around the infracarinal oesophagus, involving the lymph nodes at the level of the carina, was observed during thoracoscopic esophagectomy in 32 of the 35 patients included in the retrospective study and in 19 of the 20 patients included in the prospective study. A thick fascia-like structure from the upper thoracic aperture to the lower thoracic aperture was visualized in all patients. This fascia is encountered between the descending aorta and left aspect of the infracarinal oesophagus. Above the carina it expands on both sides of the oesophagus to lateral mediastinal structures. This fascia contains oesophageal vessels, lymph vessels and nodes and nerves. The histologic study confirmed these findings. Conclusions: Here we described the concept of the 'meso-oesophagus'. Applying the description of the meso-oesophagus will create a better understanding of the oesophageal anatomy, leading to more adequate and reproducible surgery. [ABSTRACT FROM AUTHOR]

Histological and histochemical features of the oesophagogastric segment of the alimentary canal as well as ultrastructure of gastric gland cells of freshwater tubenose goby Proterorhinus semilunaris were examined. The studies revealed that despite the lack of anatomical distinction, the oesophagogastric segment is histologically divided into the oesophagus, oesogaster and stomach, which provides evidence for the functional compartmentation of this organ. The oesophagus was characterised by the presence of numerous goblet cells secreting mainly a mixture of neutral and acid mucopolysaccharides. In the stomach, the apical zone of the surface epithelial cells contained neutral mucopolysaccharides. Numerous proliferating cells were scattered throughout the surface epithelium. In the lamina propria of the stomach, a well-developed layer of gastric glands was observed. The glands were of the alveolar type and occupied nearly the entire length of the stomach except the pyloric region. The gastric gland cells were varied into light and dark; however, their ultrastructure was identical. All cells had numerous mitochondria and a well-developed tubulovesicular system typical for the oxynticopeptic cells, but pepsinogen granules were not present in the cytoplasm of these cells. These findings contribute new evidence to literature reports that not all gobiid fish are stomachless. Moreover, they suggest higher adaptation of the species to utilise protein-rich food compared to stomachless fish, and its ability to adjust the alimentary canal quickly to changing diet. How this may facilitate establishment of P. semilunaris in invaded environments remains an open question. [ABSTRACT FROM AUTHOR]

Histochemical properties of the mucus cells in oesophagus and stomach in a teleost, black tetra ( Gymnocorymbus ternetzi), are described and compared. These cells were sac-shaped, very numerous, and embraced by ordinary epithelial cells with highly variable shape, throughout the entire length of oesophagus. The stomach luminal epithelial cells were filled with mucin apically, whereas the gastric gland cells lacked mucin. When treated with alcian blue (pH 2.5) before periodic acid-Schiff, the oesophagus mucin displayed a colour between blue and magenta, whereas it was strongly magenta in stomach. After high iron diamine followed by alcian blue (pH 2.5), the oesophagus mucin displayed a clean blue colour, whereas the stomach mucin was uncoloured. The present results for the lectin affinities in mucus cells in oesophagus of black tetra were similar to those of stomach and together suggest that these mucins contain significant amounts of N-acetylglucosamines, galactose- N-acetylgalactosamines sequences, and probably some sialic acid in terminal positions attached to the N-acetylglucosamine, but the mucin seems nearly or entirely to lack glucose and mannose. In addition, all its N-acetylgalactosamines in oesophagus, unlike in stomach, seem to be attached to galactose, as these amines were not coloured by DBA in oesophagus, but intensely coloured by PNA. Together the present results suggest that the oesophagus mucin in black tetra contains both neutral and carboxylated glycoproteins, but lacks sulphated glycoproteins, whereas the stomach mucin contains neutral glycoproteins only. The present results for black tetra suggest that the large amounts of oesophageal mucus and its increased toughness caused by anions may largely compensate for the lack of salivary glands. The stomach mucin lacks anions, a feature which may enhance the flow of the mucus and therefore also its ability to clean and protect the stomach wall against the gastric juice. [ABSTRACT FROM AUTHOR]

Introduction: The non-steroid anti-inflammatory drugs (NSAIDs) are among the drugs that can commonly cause injury in the esophagus, such as non-reflux oesophagitis, with important clinical consequences. This injury may be 'silent' and therefore often overlooked. Recently, we established that hydrogen sulfide (HS) is a critical mediator of esophageal mucosal protection and repair. The aim of the study was to determine the effect of naproxen, the most commonly used NSAIDs, on the oesophagus and oesophagogastric junction and its relation with suppression or stimulation of endogenous HS synthesis during naproxen-induced oesophageal injury. Methods: Rats were treated with vehicle (control) or naproxen, with or without being subjected to water immersion restricted stress (Takagi et al. Chem Pharm Bul 12:465-472, ). Subgroups of rats were pre-treated with an inhibitor of HS synthesis cystathionine γ-lyase (CSE) or cystathionine β-synthase (CBS), or with the Sodium sulphide (NaHS), which spontaneously generates HS in solution. Damage of the oesophageal mucosa and oesophagogastric junction was estimated and scored using a histological damage index. Results: Treatment with naproxen increased the thickness of the corneal and epithelial layers of the oesophagus, as well as producing disorganization of the muscle plate and irregular submucosal oedema. Both injury factors, stress and suppression of HS synthesis resulted in the development of severe esophagitis and damage to the oesophagogastric junction. The damage was exacerbated by inhibitors of HS biosynthesis, and attenuated by treatment with NaHS. Conclusions: Inhibition of endogenous HS synthesis provides a novel experimental model that can be useful in preclinical studies NSAID-related non-reflux oesophagitis. HS contributes significantly to mucosal defence in the oesophagus. [ABSTRACT FROM AUTHOR]

Oesophageal diverticulum is divided into two types based on the aetiology: the pulsion and the traction diverticula. Pulsion diverticulum occurs due to increased intraluminal pressure. This can be of three types based on the location along the oesophagus: the Zenker's diverticulum (ZD), the mid-oesophageal diverticulum (MD) and the epiphrenic diverticulum (ED). A PubMed search was conducted for the words 'pulsion', 'diverticulum' and 'oesophagus' for all studies published from January 1980 to March 2013 in the English language. A total of 31 studies were identified, and out of which, five were not included in the review. The pulsion diverticulum of the oesophagus is an uncommon disorder. Its aetiology is related to the motility disorders of the oesophagus. Patients usually present with chest-related symptoms or oesophageal symptoms, which are related to the underlying motility disorder. Evaluation includes barium studies, gastrointestinal endoscopy, CT scan and oesophageal manometry. Surgery is the treatment of choice for symptomatic and large diverticula, although the outcome in asymptomatic patients is unknown. The surgical options include diverticulectomy or diverticulopexy with an adequate myotomy. Most patients with ZD are now treated by using endoscopic techniques, although no randomised trial has shown its superiority over the open technique. Minimally invasive surgery has also been used for patients with MD and ED. Although isolated case series has shown good improvement in symptoms and reduction in mortality with minimally invasive techniques in patients with ED, its role in thoracic oesophageal diverticulum is debated. [ABSTRACT FROM AUTHOR]

Hirudiniasis is caused by sanguivorous leeches feeding on mucous membranes with possible severe obstructive or haemorrhagic manifestations. Few cases have been reported in humans, and most occur in tropical countries. A seventy-year-old female patient presented to our Emergency Department (ED) with retrosternal discomfort. She was taking warfarin for a mechanical prosthetic heart valve. While in the ED, a leech was spontaneously extruded from her mouth, with symptomatic resolution. Endoscopy revealed an area of previous leech attachment in the distal oesophageal, without severe bleeding. Albeit uneventful, this case could have had a devastating outcome. [ABSTRACT FROM AUTHOR]

Objectives: To outline the current role and future potential of magnetic resonance imaging (MRI) in the management of oesophageal cancer regarding T-staging, N-staging, tumour delineation for radiotherapy (RT) and treatment response assessment. Methods: PubMed, Embase and the Cochrane library were searched identifying all articles related to the use of MRI in oesophageal cancer. Data regarding the value of MRI in the areas of interest were extracted in order to calculate sensitivity, specificity, predictive values and accuracy for group-related outcome measures. Results: Although historically poor, recent improvements in MRI protocols and techniques have resulted in better imaging quality and the valuable addition of functional information. In recent studies, similar or even better results have been achieved using optimised MRI compared with other imaging strategies for T- and N-staging. No studies clearly report on the role of MRI in oesophageal tumour delineation and real-time guidance for RT so far. Recent pilot studies showed that functional MRI might be capable of predicting pathological response to treatment and patient prognosis. Conclusions: In the near future MRI has the potential to bring improvement in staging, tumour delineation and real-time guidance for RT and assessment of treatment response, thereby complementing the limitations of currently used imaging strategies. Key Points: • MRI's role in oesophageal cancer has been somewhat limited to date. • However MRI's ability to depict oesophageal cancer is continuously improving. • Optimising TN-staging, radiotherapy planning and response assessment ultimately improves individualised cancer care. • MRI potentially complements the limitations of other imaging strategies regarding these points. [ABSTRACT FROM AUTHOR]

Aim — Background: Barrett’s oesophagus is a condition caused by acid reflux from the stomach to the oesophagus for a prolonged period of time. Patients with Barrett’s oesophagus are at significant risk of developing oesophageal adenocarcinoma. This risk decreases with antireflux surgery. Treatment of gastroesophageal reflux disease (GERD) by Nissen fundoplication surgery has a success rate of 85–90%. The aim of this study is to highlight the significance of oesophageal pH measurement as part of the postoperative follow-up of patients diagnosed with Barrett’s oesophagus who undergo the Nissen fundoplication procedure. Patients and methods: Between 2010 and 2012, eleven patients with Barrett’s oesophagus underwent Nissen fundoplication in our clinic, followed by 48h wireless oesophageal pH-metry monitoring. Results: All patients reported relief of GERD typical symptoms. Mean DeMeester score of 1.5 was measured at the fifth postoperative month. Conclusion: Prevention of oesophageal adenocarcinoma in patients with Barrett’s oesophagus is crucial. These patients are exposed to a great risk of adenocarcinoma development, not only owing to the potential progression of Barrett’s oesophagus to adenocarcinoma, but also because of the decreased capacity to experience typical GERD symptoms. Given the possibility of antireflux surgery failure and the fact that symptoms may be an unreliable indicator of GERD presence, postoperative oesophageal pHmetry is mandatory. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess whether patients diagnosed with oesophageal or gastric cancer at a local district general hospital (the 'spoke') have a similar temporal pathway through the decision-making and treatment process compared to those patients presenting at the centralised, tertiary hospital (the 'hub'). Methods: Between April 2010 and April 2011, patients with a new diagnosis of oesophagogastric cancer from both hub and spoke hospitals were analysed. Data regarding diagnosis, time from diagnosis to multidisciplinary meeting (MDM) discussion, and time from MDM decision to first treatment were all recorded. Statistical analysis was performed using parametric two-tailed t test to assess significance. Results: There was a statistically significant increase in the time from diagnosis to MDM discussion at the spoke hospital compared to the hub (13.3 days vs. 25.67 days; p = 0.001). However, time to first treatment (surgery, palliative therapy, neoadjuvant therapy, or best supportive care) was significantly increased in the hub hospital compared to the spoke (43.4 days vs. 25.5 days; p = 0.023). Conclusions: Notwithstanding its limitations, this study is the first of its kind to show that there is a disparity in the management pathways of patients who first present to a regional hospital rather than the tertiary centre. Patients at the spoke hospital have a longer lead time into the MDM but nonoperative treatment appears to be delivered more quickly locally. [ABSTRACT FROM AUTHOR]

Purpose: Tissue engineering of the oesophagus has been proposed as a therapeutic alternative to organ transplantation. We previously demonstrated that a detergent enzymatic treatment (DET) is a valid method to obtain an acellular matrix with preservation of the native architecture. In this study, we aimed to develop a natural acellular matrix from pig oesophagus, as a valid framework for oesophageal replacement. Methods: Pig oesophagi ( n = 4) were decellularized with continuous luminal infusion of DET. To evaluate the efficiency of the decellularization, samples were assessed by histology and DNA quantification. Moreover, the ultra-structural characteristics of the acellular matrix were investigated by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: Decellularization of the oesophagus was achieved after three cycles of DET. Histological analysis showed the maintenance of tissue matrix architecture with absence of cellular elements, verified by measurement of DNA. SEM and TEM analysis confirmed preservation of the ultra-structural characteristics of the native tissue. Conclusions: Oesophageal acellular matrix can be successfully obtained by decellularization of pig oesophagus using a gentle DET via the oesophageal lumen. This decellularization method preserves the ultrastructure of the native tissue and could represent the basis for a tissue-engineered oesophagus. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the role of free autologous greater omentum graft in enhancing the healing process in cervical oesophagus surgical wounds. The study was carried out on eight male adult dogs, assigned equally into either an experimental or control group. All dogs underwent cervical oesophagotomy and laparotomy operations simultaneously. A 3-cm linear full thickness incision was made on the cervical oesophagus and then sutured. A small piece of omentum was obtained from the abdominal cavity and secured on the oesophageal suture line in the experiment group. In the control group, the suture line was left without a graft and the isolated omentum disposed. During this study, the dogs were examined clinically and euthanized on day 14. The surgical site on the oesophagus was assessed macroscopically, and then histopathologic samples were taken from the repaired tissue of the oesophageal wall. The samples were stained by haematoxylin-eosin and Masson's trichrome. The results demonstrated that there were no significant differences based on clinical and macroscopic examination between the two groups. The microscopic study revealed that cellularity, angiogenesis and granulation tissue formation in the wound bed in the experimental group was significantly more than in the control group. The application of autologous free omental graft can influence cervical oesophagus wound healing through augmentation of angiogenesis, cell infiltration and granulation tissue formation. [ABSTRACT FROM AUTHOR]

A lateral soft tissue neck radiograph is a useful adjunct in diagnosing and managing the patient presenting with upper airway symptoms but is often inadequately reviewed. We present some common findings and robust systems to improve analysis of these radiographs. [ABSTRACT FROM AUTHOR]

This paper analytically investigates the unsteady peristaltic transport of the Maxwell fluid in a finite tube. The walls of the tube are subjected to the contraction waves that do not cross the stationary boundaries. The analysis is carried out by a long wavelength approximation in the non-dimensional form. The expressions for the axial and radial velocities are derived. The pressures across the wavelength and the tubelength are also estimated. The reflux phenomenon is discussed, which culminates into the determination of the reflux limit. Mathematical formulations are physically interpreted for the flow of masticated food materials such as bread and white eggs in the oesophagus. It is revealed that the Maxwell fluids are favorable to flow in the oesophagus as compared with the Newtonian fluids. This endorses the experimental finding of Takahashi et al. (Takahashi, T., Ogoshi, H., Miyamoto, K., and Yao, M. L. Viscoelastic properties of commercial plain yoghurts and trial foods for swallowing disorders. Rheology, 27, 169-172 (1999)). It is further revealed that the relaxation time does not affect the shear stress and the reflux limit. It is found that the pressure peaks are identical in the integral case while different in the non-integral case. [ABSTRACT FROM AUTHOR]

Background: Interventional pulmonology, in particular, tracheobronchial stent insertion, has been well described in the treatment of tracheobronchial malignant disease. Its benefits are particularly obvious in patients with inoperable malignancy or in those unfit for surgery and have been extensively described. Fewer data exist on the benefits of using self-expanding metal stents (SEMS) inserted via flexible bronchoscopy in the treatment of tracheobronchial stenosis due to extrinsic compression or infiltration from primary oesophageal malignancy. Methods: We retrospectively reviewed all patients who had stent insertion via flexible bronchoscopy from 2002 to 2010 at our institution. Results: We found 14 patients who had Ultraflex™ self-expanding metal stent insertion for this condition. We analysed this group of patients with respect to their presentation; indications for stent insertion over surgery; size, location, and number of stents inserted; sedative dose; complications of therapy; and survival time. Conclusion: We conclude that insertion of SEMS via flexible bronchoscopy is a safe and effective therapy for those individuals who require palliation or are too unfit for the general anaesthesia required for surgery. Moreover, this form of stent insertion may be performed by respiratory physicians in the bronchoscopy suite, rather than by their cardiothoracic counterparts in theatre. [ABSTRACT FROM AUTHOR]

Interventional radiology is a rapidly growing discipline in paediatrics. Many non-vascular interventional techniques may be used in the gastrointestinal tract in children. The technically simpler and more common of these may be adopted by any paediatric radiologist with an interest in interventional radiology. Other rarer and more complex techniques are currently restricted to specialist centres with a higher overall caseload. This review emphasizes the common procedures such as oesophageal dilatation, gastrostomy, insertion of transgastric jejunal feeding tubes and biopsy. Less common salivary, hepatobiliary, pancreatic and intestinal interventions are also described. [ABSTRACT FROM AUTHOR]

Background: There is an unexplained male predominance in the incidence of oesophageal adenocarcinoma, and the sex-specific distribution of its risk factors in the general population is not known.Methods: A random sample of Swedish citizens aged 40-79 years completed a questionnaire for assessment of the prevalence of five risk factors for oesophageal adenocarcinoma: reflux symptoms, body mass index, tobacco smoking habits, socioeconomic status, and use of non-steroidal anti-inflammatory drugs (NSAIDs). Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the association of these risk factors, separately and combined, with male sex, with women as reference.Results: Among 6969 invited people, 4906 (70.4%) completed the questionnaire. Adjusted prevalence estimates showed a negative association with male sex with regard to reflux disease (OR=0.70, 95% CI=0.58-0.84), whereas overweight (OR=1.98, 95% CI=1.72-2.27) and obesity (OR=1.22, 95% CI=1.01-1.47), previous smoking (OR=1.50, 95% CI=1.30-1.72), and no NSAID use (OR=1.35, 95% CI=1.15-1.49) were positively associated.Conclusions: Exposure to some but not all established risk factors for oesophageal adenocarcinoma seems to be more common in men than in women, but the differences are small and unlikely to explain the male predominance of this tumour. [ABSTRACT FROM AUTHOR]

Interstitial cells of Cajal (ICC) are morphologically and functionally intercalated between the elements of the enteric nervous system and the smooth muscle cells (SMCs) in the musculature of the digestive tract. Kit immunohistochemistry reliably identifies the location of these cells and provides information on changes in ICC distribution and density. Human oesophagus specimens (7 embryos, 23 fetuses at 7-27 weeks gestational age; both sexes) were exposed to Kit antibodies to determine ICC differentiation. Enteric plexuses were examined immunohistochemically by using anti-neuron-specific enolase, whereas the differentiation of SMCs was studied with antibodies against α-smooth-muscle actin and desmin. By week 7, c-kit-immunopositive cells were present along the entire oesophagus in the form of an uninterrupted layer around the myenteric plexus (MP) elements. From the beginning of the 3rd month, the number of ICC progressively decreased around the MP ganglia but increased within the muscle layers. Concomitantly, differences in the number and distribution of ICC were established in the various portions of the oesophagus: specifically, ICC were abundant in the lower portion, less numerous in the middle region and rare in the upper part. By the 5th month of development, the relationship as found in later developmental stages had been established: C-kit IR ICC were present within the circular muscle layer, within the longitudinal layer and in the connective septa surrounding the muscle bundles but were completely missing around the MP ganglia. [ABSTRACT FROM AUTHOR]

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The valve of Leiblein is a morphological synapomorphy defining Neogastropoda, but is also a significant adaptation in the evolution of carnivorous, predatory feeding and homologues have not been recognised amongst non-neogastropods to date. This study uses histology to examine the valve of Leiblein and associated oesophageal features of a buccinoidean ( Euplica scripta—Columbellidae) and two muricoideans ( Morula marginalba—Muricidae, and Columbarium pagodoides—Turbinellidae), and comparisons are made with the oesophagus of four non-neogastropods; the tonnoidean out-group Cabestana spengleri and three other littorinimorph caenogastropods. Several morphological details conflict with earlier descriptions of different neogastropod species, such as the presence of a diverticulum in the muricoidean valve and torsion in the buccinoidean valve. This supports recent findings that the valve of Leiblein is morphologically heterogeneous, but, unlike some other studies, does not dispute the homology of the valve in different neogastropod groups. Structure and histology support the homology of the valve of Leiblein in Muricoidea and Buccinoidea and its derivation from elements of the anterior oesophagus of higher littorinimorph caenogastropods (Tonnoidea). A thick, secretory, pseudostratified epithelium lining the ventral anterior oesophagus of C. spengleri is comparable with the tissue lining the glandular chamber of the valve of Leiblein. A modified theory regarding the evolutionary origin of the valve of Leiblein is proposed in which it is homologous to the anterior oesophagus of Tonnoidea. [ABSTRACT FROM AUTHOR]

We present the case of a 46-year-old woman diagnosed with a primary oesophageal melanoma (PEM), who was treated with radical surgery followed by combined chemoimmunotherapy (interferon, carboplatin, dacarbazine and external radiotherapy) and who achieved a complete response after this treatment. PEMs are rare malignancies, with less than 300 cases described in the literature. The main differential diagnosis is with metastases of skin or ocular malignant melanomas. They are usually diagnosed at advanced stages and prognosis is typically poor. The main treatment modality should be radical surgery. The role of adjuvant treatment is uncertain, although some long responses have been seen with the use of chemotherapy or immunotherapy alongside surgery. [ABSTRACT FROM AUTHOR]

Background: In the United States, the rates and temporal trends of oesophageal cancer overall and for the two predominant histologic types - adenocarcinoma (ADC) and squamous cell carcinoma (SCC) - differ between Blacks and Whites, but little is known with regard to the patterns among Asians/Pacific Islanders or Hispanics.Methods: Using the Surveillance, Epidemiology, and End Results programme data, we analysed oesophageal cancer incidence patterns by race, sex, and histologic type for the period 1977-2005.Results: Total oesophageal cancer incidence has been increasing among Whites only; the rates among all other race groups have declined. Moreover, rates among White men surpassed those among Blacks in 2004. Oesophageal SCC rates have been decreasing among virtually all racial/ethnic groups; rates among Hispanic and Asian/Pacific Islander men have been intermediate to those of Blacks and Whites, with rates among women being lower than those among Blacks or Whites. The ADC rates among Hispanic men may be rising, akin to the historical trends among Whites and Blacks. The sex ratios for these cancers also varied markedly.Conclusions: These observations may provide clues for aetiological research. [ABSTRACT FROM AUTHOR]

Treatment of oesophageal perforation remains controversial. This study shows that native oesophagus should be preserved. Early recognition improves survival. The aim of this study was to evaluate the outcome of management of post dilatation oesophageal perforation in a tertiary centre. Between 1999 and 2007, 35 patients with oesophageal perforation following dilatation were treated. Post dilatation corrosive stricture perforations constituted the major aetiology. Twenty-four (69%) underwent early intervention (< 24 hours) and the remaining 11 (31%) were late (>24 hours). The 30-day mortality was found to be 9%, and mean hospital stay was 14 ± 14.7 days. Comparing outcomes between early and late groups, statistically significant difference was observed, with increased mortality (p=0.001) and hospital stay (p=0.001) following late intervention. Early intervention decreases mortality and hospital stay in oesophageal perforation and preservation of oesophagus may be attempted, as native oesophagus is the best conduit. [ABSTRACT FROM AUTHOR]

A nationwide Swedish case-control study of 388 men and 63 women with adenocarcinoma of the oesophagus and gastro-oesophageal function and 676 men controls and 140 women investigated whether sex differences in aetiology contribute to male predominance. Compared with men, women seemed more vulnerable to reflux (odds ratio (OR)=4.6, 95% confidence interval (CI)=2.0-10.5 vs OR=3.4, 95% CI=2.5-4.6), obesity (OR=10.3, 95% CI=2.6-42.3 vs OR=5.4, 95% CI=2.6-10.8) and smoking (OR=5.3, 95% CI=2.0-14.1 vs OR=2.8, 95% CI=1.9-4.2), less harmed by low intake of fruit and vegetables (OR=0.9, 95% CI 0.3-2.4 vs OR=1.6, 95% CI=1.1-2.2) and less protected by Helicobacter pylori infection (OR=0.5, 95% CI=0.3-0.8 vs OR=1.6, 95% CI=0.5-5.4). [ABSTRACT FROM AUTHOR]

Patients with acute oesophageal obstruction, either due to a foreign body or food bolus, present to any of the specialties of Otorhinolaryngology, General Surgery, Cardiothoracic Surgery or Gastroenterology. To review current routine management of this condition, we conducted a postal survey of all the consultants in the aforementioned specialties in the South Thames region. The aims of the survey were to assess current practice and to produce a standardized management plan for these patients. [ABSTRACT FROM AUTHOR]

Combination chemotherapy regimens can improve survival in patients with advanced gastric and oesophageal adenocarcinoma. Docosahexaenoic acid (DHA)-paclitaxel is a novel conjugate formed by the covalent linkage of the fatty acid DHA to paclitaxel and may result in increased tumour exposure to paclitaxel without increased toxicity. In this single arm, phase II study of DHA-paclitaxel, eligible patients with previously untreated, inoperable locally advanced or metastatic adenocarcinoma of the oesophagus, oesophago-gastric junction or stomach were treated with DHA-paclitaxel (1,100 mg/m2) administered by 2-h intravenous infusion every 21 days. Fifty-four patients were recruited of whom 53 were evaluable for toxicity, and 48 for response. There were five confirmed partial responses (9.4%) by the RECIST criteria. The median duration of response was 87 days (range 49–97 days), the median time to progression was 84 days (95% CI 78–124 days), and median overall survival was 262 days (95% CI 205–357 days). Grade ≥3 neutropaenia occurred in 93% of patients, and febrile neutropaenia in 17% of patients. DHA-paclitaxel has modest activity in patients with oesophago-gastric cancer and with haematological toxicity that is comparable to paclitaxel and docetaxel. [ABSTRACT FROM AUTHOR]