Search

To date, empirical literature has generally been considered lacking in relation to neuroendocrine carcinomas (NECs), the highly malignant subgroup of neuroendocrine neoplasms. NECs are often found in the lungs or the gastroenteropancreatic (GEP) system and can be of small or large cell type. Concentrating on GEP-NECs, we can conclude that survival times are poor, with a median of only 4-16 months depending on disease stage and primary site. Further, this aggressive disease appears to be on the rise, with incidence numbers increasing while survival times are stagnant. Treatment strategies concerning surgery are often undecided and second-line chemotherapy is not yet established. After an analysis of over 2600 articles, we can conclude that there is indeed more empirical literature concerning GEP-NECs available than previously assumed. This unique review is based on 333 selected articles and contains detailed information concerning all aspects of GEP-NECs. Namely, the classification, histology, genetic abnormalities, epidemiology, origin, biochemistry, imaging, treatment and survival of GEP-NECs are described. Also, organ-specific summaries with more detail in relation to disease presentation, diagnosis, treatment and survival are presented. Finally, key points are discussed with directions for future research priorities. [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]

Congenital oesophageal stricture was diagnosed via endoscopy in a 3-day-old Arabian filly suffering from nasal milk regurgitation. Vascular ring anomaly or other extramural, intramural or intraluminal causes were not identified on radiographs or on a computed tomography scan; thus a functional abnormality was suspected. The filly was treated with antibiotics for aspiration pneumonia and was fed milk through an indwelling nasoesophageal tube. Two sessions of balloon bougienage at the stenotic site, under sedation, resulted in marked clinical improvement and thereafter the filly was gradually reintroduced to suckling from the mare. The filly was discharged from the hospital after 17 days and on follow-up there were no reports of food regurgitation even after the introduction of solid food. The filly was still doing well in the latest follow-up at age 11 months. [ABSTRACT FROM AUTHOR]

Introduction Gastrointestinal stromal tumours (GIST) account for only one percent of all gastrointestinal malignancies. Presentation of case A 53 year old lady presented to the gastroenterology clinic with iron deficiency anaemia. Oesophagogastroduodenoscopy (OGD) and computed tomography (CT) demonstrated a non-obstructing 7 cm submucosal oesophageal lesion. An oesophagectomy was performed and subsequent histology sections showed a well-circumscribed spindle cell tumour without any cellular atypia. Immunohistochemistry on the tumour was negative for S100 and positive for smooth muscle actin and desmin. C-kit (CD117) showed focal positivity in some of the tumour cells and the overall features were of a gastro-intestinal stromal tumour (GIST). The patient has been fully compliant with the follow-up arrangements and is disease-free six years after her original operation. Discussion GISTs are mesenchymal tumours of the gastrointestinal (GI) tract that express the KIT protein. The incidence rate for GIST is 15 cases to one million in the USA. GISTs in the oesophagus are rare (5%) and their management is surrounded by some debate. Once the diagnosis has been secured the patient should be evaluated for suitability for surgical resection. Optimal surgical therapy should aim to achieve complete resection, if possible, without injury to the pseudocapsule surrounding the tumour. Meticulous atraumatic surgical technique is necessary and preoperative biopsies are best to be avoided as they might propagate seeding. Conclusions Oesophagectomy with clear resection margins should be the preferred method for surgical treatment combined with the use of novel TKI strategies. [ABSTRACT FROM AUTHOR]

There are strong medical motivations to measure changes in material properties of tubular organs, in vivo and in vitro. The current approach estimates hoop stress from intraluminal pressure using the Laplace law and identifies 'elastic modulus' as the slope of a curve fitted hoop stress plotted against strain data. We show that this procedure is fundamentally flawed because muscle and other soft tissue are closely incompressible, so that the total stress includes a volume-preserving material-dependent hydrostatic response that invalidates the method. Furthermore, we show that the Laplace law incorrectly estimates total stress in biological vessels. However, the great need to estimate elastic modulus leads us to develop an alternative practical method, based on shear stress-strain, i.e. insensitive to nonelastic response from incompressibility, but that uses the same measurement data as the current (incorrect) method. The individual material parameters in the underlying (unknown) constitutive relation combine into an effective shear modulus that is a true measure of elastic response, unaffected by incompressibility and without reference to the Laplace law. Furthermore, our effective shear modulus is determined directly as a function of deformation, rather than as the slope of a fitted curve. We validate our method by comparing effective shear moduli against exact shear moduli for four theoretical materials with different degrees of nonlinearity and numbers of material parameters. To further demonstrate applicability, we reanalyse an in vivo study with our new method and show that it resolves an inconsistent change in modulus with the current method. [ABSTRACT FROM AUTHOR]

In the present work we describe a 2-year-old boy whose battery ingestion was overlooked, and who had the battery endoscopically removed from the upper part of his oesophagus after several months. This is the only described case of such a long impaction of a lithium battery in the oesophagus, without development of severe complications. We stress the necessity to take into account ingestion of a dangerous foreign body by children demonstrating unspecific clinical signs. [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]

Aims This single-centre retrospective study evaluated combination external beam radiotherapy and high dose rate brachytherapy for patients in whom radical treatment was appropriate but comorbidity or frailty excluded this as an option. Materials and methods In total, 59 patients were selected for a combined approach and treated between October 2000 and October 2011; 68% were male. The median age was 77 years (range 53–88 years); 66% had adenocarcinoma, 31% squamous cell carcinoma. Tumour stage: I: 20%, II: 43%, III: 32% and IV: 3%. External beam radiotherapy doses of either 27 Gy/six fractions or 30 Gy/10 fractions were delivered, followed by high dose rate brachytherapy at doses of either 10 or 15 Gy utilising an iridium 192 source at 1 cm. Results The median overall survival of all treated patients was 12.3 months; 1, 2 and 3 year survival rates were 51, 19 and 7%, respectively. Patients with stage I disease had a median survival of 16 months compared with 10 months for patients with stage III disease ( P = 0.036). The pretreatment dysphagia score was associated with survival ( P = 0.021). Conclusions This study shows the value of a purely radiation-based approach in a selected population. Treatment is deliverable with excellent compliance and the median survival compares favourably with unselected patients treated palliatively in our institution. [ABSTRACT FROM AUTHOR]

This paper highlights the clinical and plain radiographic features that assisted in accurate localisation of the radiolucent dental prostheses impacted in the cervical oesophagus of nine patients. These patients presented to the author at the University of Nigeria Teaching Hospital and Balsam Clinics, both in Enugu, Nigeria between February 1994 and January 1998 with history of swallowed and impacted dental protheses in the throat. Localisation of site of impaction was exact in all cases by clinical examination, plain neck radiographs and at rigid oesophagoscopy. The diagnostic radiographic features are widening of retrotrachael region, indentation of trachae and air entrapped in oesophagus. Seven were removed at rigid oesophagoscopy and two by cervical oesophagotomy. It concludes that clinical history, physical examination and plain soft tissue lateral neck radiographs are adequate for full diagnosis. Most dental protheses in unperforated cervical oesophagus could safely be extracted endoscopically, a method that has less morbidity than cervical oesophagotomy.

Oesophageal penetration and migration of foreign bodies are fairly rare occurrences. Most reported cases in the literature involve fish bones, which are eventually found in the lateral neck soft tissue or thyroid lobule. We present a case of a migrating fish bone in an elderly female which was found embedded in her right sternocleidomastoid muscle. The fish bone was successfully removed via neck exploration. Appropriate literature is reviewed.

Background: Endoscopic ultrasonography is recommended for staging gastro-oesophageal cancers, but has never been evaluated. Objective: COGNATE (Cancer of Oesophagus or Gastricus – New Assessment of Technology of Endosonography) therefore aimed to evaluate whether adding ‘endoscopic ultrasound’ (EUS) to the usual staging algorithm changes treatment, improves (quality-adjusted) survival, and uses resources cost-effectively. Design: Pragmatic parallel-group trial. Patients with gastro-oesophageal cancer received standard staging algorithms. Multidisciplinary teams chose provisional management plans from endoscopic mucosal resection, immediate surgery, surgery after chemotherapy, or chemotherapy and radiotherapy. We used dynamic randomisation to allocate consenting patients remotely by telephone in equal proportions between EUS and not. Thereafter we recorded changes in management plan, use of health-care resources, and three aspects of participant-reported quality of life: generic [measured by European Quality of Life – 5 Dimensions (EQ-5D)], cancer related [Functional Assessment of Cancer Therapy – General scale (FACT-G)] and condition-specific [FACT – Additional Concerns scale (FACT-AC)]. We followed participants regularly until death or the end of the trial – for between 1 and 4.5 years. We devised a quality assurance programme to maintain standards of endosonographic reporting. Setting: Eight British hospitals, of which two – one Scottish teaching hospital and one English district general hospital – contributed 80% of participants; we combined the other six for analysis. Participants: Patients were eligible if they had a diagnosis of gastro-oesophageal cancer, had not started treatment, were free of metastatic disease, were fit for surgery (even if not planned) and had American Society of Anesthesiologists and World Health Organization grades of less than 3. Interventions: Intervention group: standard staging algorithm plus EUS; control group: standard staging algorithm. Main outcome measures: Primary: quality-adjusted survival. Secondary: survival; health-related quality of life (EQ-5D, FACT-G and FACT-AC scales); changes in management plan; and complete resection rate. Although blinding participants was neither possible nor desirable, those responsible for analysis remained blind until the Trial Steering Committee had reviewed the definitive analysis. Results: We randomised 223 patients, of whom 213 yielded enough data for primary analysis. EUS improved survival adjusted for generic quality of life with a hazard ratio of 0.705 [95% confidence interval (CI) 0.499 to 0.995], and crude survival with a hazard ratio of 0.706 (95% CI 0.501 to 0.996). The benefits of EUS were significantly greater for those with poor initial quality of life, but did not differ between centres. EUS reduced net use of health-care resources by £2860 (95% ‘bootstrapped’ CI from −£2200 to £8000). Combining benefits and savings shows that EUS is likely to be cost-effective, with 96% probability of achieving the National Institute for Health and Care Excellence criterion of costing of < £20,000 to gain a QALY. There were no serious adverse reactions attributable to EUS. EUS enhanced the management plan for many participants, increased the proportion of tumours completely resected from 80% (44 out of 55) to 91% (48 out of 53), and improved the survival of those who changed plan; although underpinning the significant differences in outcome, none of these process differences was itself significant. Conclusion: Endoscopic ultrasound significantly improves (quality-adjusted) survival, has the potential to reduce health-care resource use (not statistically significant) and is probably cost-effective (with 96% probability). We recommend research into the best time to evaluate new technologies. Trial registration: ISRCTN1444215. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 39. See the HTA programme website for further project information.

[english] We analysed the typical features of primary small cell carcinoma of the esophagus (SCCE) with emphasis on occurrence, behaviour, outcome and treatment options. This metaanalysis was aimed at collecting and analyzing information from international studies about handling this disease. This seems necessary due to the rarity of this disease. Studies were acquired from electronic databases and reference lists. We finally analysed 313 patient cases from the literature with oesophageal SCC. A data extraction was accomplished referring to 13 evaluable features that are described in the “methods”, whereof 7 were analyzed with univariate and multivariate tests. Three hundred thirteen cases were analyzed, 109 patients (35%) had limited stage (LS), whereas 167 (54%) had extensive stage (ES). There is no information about the remaining 35 patients concerning the stage. Univariate and multivariate analysis showed only age (50 years, HR 1.024; 95% CI 1.000–1.041, 50 years) and therapy are independent significant predictors of prognosis.[german] Gegenstand unserer Untersuchungen war die Erhebung typischer Eigenschaften des kleinzelligen Ösophaguskarzinoms mit Berücksichtigung des Auftretens, des Verlaufs, der Auswirkung und der Behandlungsoptionen. Ziel unserer Metaanalyse bestand darin, Informationen aus internationalen Studien, die sich mit dieser Krankheit befassten, zu sammeln und auszuwerten. Dies scheint notwendig aufgrund der Seltenheit der Krankheit. Die verwendeten Studien wurden von elektronischen Datenbanken und Referenzlisten ermittelt. Insgesamt wurden 313 Patientenfälle mit einem kleinzelligen Ösophaguskarzinom aus der Literatur ausgewertet. Die erhobenen Daten beziehen sich auf 13 auswertbare Kriterien, die in den „Methoden“ beschrieben sind, wovon sieben Kriterien mit univariaten und multivariaten Tests untersucht worden sind. Von 313 analysierten Patientenfällen waren 109 (35%) Patienten im limitierten Stadium der Erkrankung und 167 (54%) im ausgedehnten Stadium. Über die übrigen 35 Patienten sind keine Informationen bezüglich des Stadiums bekannt. Univariate und multivariate Analysen zeigten nur das Alter (50 Jahre, HR 1.024; 95% CI 1.000–1.041, 50 Jahre) und die Therapie als Kriterien eigenständige, signifikante Anzeichen für eine Prognose sind.

Although ingestion of foreign body in oesophagus is common in pediatric age group, its occurrence in neonatal period is rare. Etiology behind these foreign bodies may be negligence or homicidal attempt for unwanted child. A high index of suspicion is required for diagnosis, whenever the neonate presents with symptoms related either to the respiratory or gastrointestinal tract. Delayed diagnosis can result in serious complications. We report a very unusual case of twin foreign body (glass marble) in oesophagus in a 30 days old female neonate. The peculiarity of this case concerns the unusual foreign body and age of the patient.

Aim Boerhaave's syndrome, or spontaneous oesophageal rupture, is a rare but serious condition. The pathology involved is a complete, transmural laceration of the oesophagus. The overall mortality rates are still high (range: 10-60 per cent). Outcomes of oesophageal perforations depend on the duration between diagnosis of perforation and treatment. Primary repair has been identified as the best treatment option, especially for presentation before 24 h. Mediastinal pleura, gastric fundus, pericardial flap and intercostal muscle flap are frequently used. Reversed latissimus dorsi (LD) muscle flap is another feasible option, especially when the intercostal muscle is inadequate and the length of perforation is long. Patients and Methods A patient presented with Boerhaave's syndrome with left posterolateral thoracotomy done. Intraoperation found a 4-cm, full-thickness perforation over the distal oesophagus. Primary repair and reinforcement with reversed LD muscle flap was performed. Results The patient had an uneventful recovery. Water-soluble contrast enema confirmed no leakage. He was discharged on postoperative day 10. Conclusion Primary repair and reinforcement with reversed LD muscle flap is a feasible option when the intercostal muscle is inadequate and the length of the oesophageal perforation is long. [ABSTRACT FROM AUTHOR]

Oesophageal mucocele is an uncommon complication of bipolar exclusion of oesophagus. Traditionally, this condition is managed through thoracotomy which is associated with significant morbidity. The present report outlines the thoracoscopic management of oesophageal mucocele following surgical exclusion for oesophageal perforation. Left thoracoscopic oesophagectomy for oesophageal mucocele described in this report has not been published earlier. [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]

Dietary lignans, quercetin and resveratrol have oestrogenic properties, and animal studies suggest that they synergistically decrease cancer risk. A protective effect of lignans on the development of oesophageal cancer in humans has recently been demonstrated, and the present study aimed to test whether these three phytochemicals synergistically decrease the risk of oesophageal cancer. Data from a Swedish nationwide population-based case–control study that recruited 181 cases of oesophageal adenocarcinoma (OAC), 158 cases of oesophageal squamous-cell carcinoma (OSCC), 255 cases of gastro-oesophageal junctional adenocarcinoma (JAC) and 806 controls were analysed. Exposure data were collected through face-to-face interviews and questionnaires. The intake of lignans, quercetin and resveratrol was assessed using a sixty-three-item FFQ. Reduced-rank regression was used to assess a dietary pattern, and a simplified dietary pattern score was categorised into quintiles on the basis of the distribution among the control subjects. Unconditional multivariable logistic regression provided OR with 95 % CI, adjusted for all the potential risk factors. A dietary pattern rich in lignans, quercetin and resveratrol was mainly characterised by a high intake of tea, wine, lettuce, mixed vegetables, tomatoes, and whole-grain bread and a low intake of milk. There were dose-dependent associations between simplified dietary pattern scores and all types of oesophageal cancer (all P for trend < 0·05). On comparing the highest quintiles with the lowest, the adjusted OR were found to be 0·24 (95 % CI 0·12, 0·49) for OAC, 0·31 (95 % CI 0·15, 0·65) for OSCC, and 0·49 (95 % CI 0·28, 0·84) for JAC. The results of the present study indicate that a dietary pattern characterised by the intake of lignans, quercetin and resveratrol may play a protective role in the development of oesophageal cancer in the Swedish population. [ABSTRACT FROM PUBLISHER]

Aims The incidence of oesogastric (OG) signet ring cell adenocarcinoma (SRC) is increasing in Western countries. The differential characteristics between oesophageal and gastric SRC tumours are unknown. We aimed to investigate the role of tumour location on prognosis in OG SRC. Methods Among 924 OG SRC resected in 21 centres from 1997 to 2010, consecutive patients who had oesophageal tumours (group OESO, n = 136) were matched to randomly selected patients who had gastric tumours (group GASTRIC, n = 363). Matching variables were gender, age, American Society of Anaesthesiologists score, malnutrition, pretherapeutic clinical TNM stage and neoadjuvant treatment. Patients and tumour characteristics were compared between groups and prognostic factors were identified. Results The two groups were well matched. Tumours in group GASTRIC were more advanced at surgical exploration, with higher rates of linitis plastica ( P < 0.001), peritoneal carcinomatosis ( P = 0.001), and advanced pTNM stages ( P = 0.034). Radicality of resection and recurrence rates were similar ( P > 0.480). Recurrences were more frequently distant ( P < 0.001) and peritoneal ( P < 0.001) in group GASTRIC. After adjustment on confounding variables, gastric location ( P = 0.034) was independently associated with a better prognosis than oesophageal location. Conclusion Gastric and oesophageal SRC tumours are distinct diseases. Despite similar pretherapeutic factors, gastric tumours were more advanced with a greater propensity for the peritoneal surface at the diagnosis and recurrence and associated with a better prognosis. [ABSTRACT FROM AUTHOR]

The presenting symptoms of dysphagia and dyspepsia can be caused by gastro-oesophageal reflux disease, malignancy or, less commonly, disorders of dysfunctional motility, such as achalasia. Most neoplasms of the oesophagus and stomach are epithelial in nature. Benign epithelial neoplasms usually take the form of polypoid lesions, such as oesophageal squamous papillomas, gastric adenomas, hyperplastic and fundic gland polyps. Malignant epithelial neoplasms of the oesophagus are divided into squamous cell carcinoma and adenocarcinoma, whereas malignant gastric neoplasms are predominantly adenocarcinomas. Each tends to develop in the context of dysplastic epithelial changes. This educational article provides an overview of the incidences, aetiologies and histological features of some of the most common mechanical, inflammatory and neoplastic pathologies encountered in the oesophagus and stomach. [ABSTRACT FROM AUTHOR]

Pathological specimens from columnar-lined oesophagus ( CLO) comprise a considerable proportion of the workload of gastrointestinal pathologists in Western countries. There remain controversies concerning the diagnostic role of pathology. More recently, in the UK at least, the diagnosis has been regarded as primarily an endoscopic endeavour, with pathology being corroborative and only diagnostic when endoscopic features are equivocal or when there are additional features that make the endoscopic diagnosis unclear. There is also recognition that demonstration of intestinalisation or 'goblet cells' is not paramount, and should not be required for the diagnosis. There have been notable changes in the management of CLO neoplasia: pathologists are centrally involved in its management. Pathological assessment of endoscopic mucosal resection ( EMR) specimens provides the most useful means of determining the management of early neoplasia and of determining indications for surgery. This represents an extraordinarily rapid change in management, in that, <10 years ago, laborious Seattle-type biopsy protocols were recommended, and high grade dysplasia was an indication for resectional surgery. Now, individual patient management is paramount: multi-professional meetings determine management after biopsy and EMR assessment. One significant change is that major resections are undertaken less often, in Western countries, for CLO neoplasia. [ABSTRACT FROM AUTHOR]

Résumé L’envahissement ganglionnaire est un évènement précoce et représente le principal facteur pronostique du cancer de l’œsophage. Bien que la chirurgie ait été pendant un temps challengée par la radiochimiothérapie exclusive dans les carcinomes épidermoïdes localement avancés de l’œsophage, elle est redevenue pour la majorité des patients opérables le traitement de référence car permettant un meilleur contrôle locorégional de la maladie et une survie prolongée. Pour obtenir ces résultats, la chirurgie et notamment le curage ganglionnaire doivent répondre à des critères de qualité. La définition des groupes ganglionnaires cibles du cancer de l’œsophage et de la jonction œso-gastrique, l’extension du curage ganglionnaire et son impact sur la survie sont discutés dans la présente revue, en s’appuyant sur les résultats des articles de plus haut niveau de preuve disponibles dans la littérature. Lymph node invasion is an early event in the oesophageal carcinogenesis and represents the main prognostic factor in the curative setting. Even though the primacy of surgical resection has been challenged by the definitive radiochemotherapy for locally advanced squamous cell carcinomas of the oesophagus, surgery is now again a gold standard, in combination with (radio)chemotherapy, to improve locoregional disease control and long term survival. Surgery, especially lymphadenectomy, has consequently to be standardized through quality criteria. Lymph node stations invaded in œsophageal and junctional cancers, lymphadenectomy, and its impact on outcomes are discussed in this review based on the highest level of evidence published data. [ABSTRACT FROM AUTHOR]

Despite low postoperative mortality rates, the long-term outcomes from surgical-based treatment for oesophageal cancer remain poor. Chemoradiotherapy (CRT), either given before surgical resection as neoadjuvant therapy or after resection as adjuvant therapy, has been postulated to improve these outcomes. This systematic review examines the evidence for these approaches. The evidence for postoperative radiotherapy is limited and conclusions are difficult, but it may have a role in patients at high risk of local relapse (positive margins). The addition of chemotherapy is recommended when possible. Patient selection is important due to the associated toxicities. The evidence for neoadjuvant treatment is stronger and based on the current evidence neoadjuvant CRT can be recommended as a treatment approach in T2-T4, N1-3 oesophageal cancer for both adenocarcinoma and squamous cell carcinoma, but further work is needed to establish its superiority over neoadjuvant chemotherapy alone, particularly for adenocarcinoma. We recommend that further studies divide the two histologies and they should be treated as two separate diseases. [ABSTRACT FROM AUTHOR]

Aims Atrio-oesophageal fistula is a rare but often fatal complication of catheter ablation for atrial fibrillation (AF). Various strategies are employed to evaluate the oesophageal position in relation to the posterior left atrium (LA). These include segmentation of the oesophagus from a pre-acquired computed tomography (CT) scan and direct, real-time assessment of the oesophageal position using contrast at the time of the procedure. Methods and results One hundred and fourteen patients with drug-refractory AF underwent CT scanning prior to AF ablation. The LA and oesophagus were segmented from this scan. The oesophagus was deemed midline, ostial if it crossed directly behind any of the pulmonary vein (PV) ostia, or antral if it passed within 5 mm of a PV ostium. Under general anaesthesia at the time of ablation, the same patients were administered contrast via an oro-gastric tube to outline the oesophagus. Catheters were placed at the PV ostia and oesophageal position in relation to the PVs was established radiographically using a postero-anterior view. Oesophageal position assessed by real-time assessment correlated with the CT scan in only 59% of patients. In 34% the oesophagus was more right sided on direct visualization, while in 7% it was more left sided. Conclusion Segmentation of the oesophagus from the CT scan did not correlate the real-time oesophageal position at the time of the procedure in over 40% of patients under general anaesthesia. Reliance on the determination of oesophageal position by previously acquired CT may be misleading at best and provide a false sense of security when ablating in the posterior LA. [ABSTRACT FROM PUBLISHER]

In this systematic review, we investigated the effects of goitre and its treatment on the trachea and the oesophagus. A total of 6355 papers were screened in scientific databases, which disclosed 40 original studies (nine descriptive and 31 interventional). Although most studies are hampered by a number of methodological shortcomings, it is uncontested that goitre affects the trachea as well as the oesophagus in a large proportion of people. This leads to upper airway obstruction, swallowing dysfunction, or both, which may remain undisclosed unless specifically investigated for. Assessment of the tracheal dimensions should be done by magnetic resonance imaging or computed tomography, and detection of upper airway obstruction by flow volume loops, with focus on the inspiratory component. A clinical evaluation of the oesophageal function is difficult to implement and could be replaced by available and validated questionnaires on swallowing. Although radioiodine therapy and thyroidectomy relieve the negative effect of goitre on the trachea and the oesophagus, many issues remain unexplored. [ABSTRACT FROM AUTHOR]

OBJECTIVES The specific contribution of the herniation of an abdominal antireflux fundoplication into the chest to symptomatic and therefore surgical failure remains unclear. METHODS The study was conducted in 189 consecutive fundoplication patients, categorized as patients reoperated on for chest herniation of either an abdominal 360° (Group 1; n = 95) or a partial (Group 2; n = 10) fundoplication, and patients having undergone an intrathoracic 360° fundoplication for short oesophagus (Group 3; n = 84; reference group). There were four subgroups in Group 1: 1A: wrap still complete and perioesophageal; 1B: wrap still complete but perigastric; 1C: wrap still perioesophageal but partially disrupted and 1D: wrap perigastric and partially disrupted. RESULTS The prevalence of defective symptoms (heartburn and regurgitation) was significantly lower (P < 0.0001) in Group 3 (0.0%) and Subgroup 1A (3.7%) than in Subgroups 1B (84.4%), 1C (86.7%) and 1D (100%) and Group 2 (100%). The prevalence of obstructive symptoms (dysphagia, chest pain, necrosis and perforation) was significantly higher (P < 0.0001) in Subgroup 1A (100%) than in Subgroups 1B (57.8%), 1C (60.0%) and 1D (25.0%). The prevalence of a short oesophagus, an abdominal wall hernia repair and high abdominal pressure episodes in reoperated patients were 13.7, 36.2 and 67.2%, respectively. CONCLUSIONS Unlike perigastric or partial fundoplication, a 360° perioesophageal abdominal fundoplication, when herniated into the chest, is still effective against reflux. Obstructive symptoms are due to either diaphragmatic strangulation or perigastric migration of the wrap (slipknot effect). Short oesophagus, weakness of the abdominal wall and high abdominal pressure episodes favour the herniation process. [ABSTRACT FROM PUBLISHER]

This study aimed to report our experience in clinical application of Trans- Endoscopic Ultrasound (TEUS) to the gastrointestinal tract. TEUS was performed on 9 dogs and 2 cats, using a 2.6 mm 12-20 MHz-mini-probe, introduced through the operative channel of a 9.7-mm-flexible endoscope. The ultrasonographic probe had 360° vision around the transducer (radial probe). TEUS examinations were well tolerated by all animals. Experience and practice reduced the time required for examination (on the average 45 min) for a complete endoscopic and TEUS examination. Out of 11 animals, two had esophageal stenosis, two showed gastric carcinoma, two had duodenitis, two exhibited rectal polyposis, one had lymphoma and ileocecal intussusception, one had rectal adenocarcinoma and one showed chronic gastritis. Thus, combination of ultrasound and endoscopy allowed intrinsic limits of both techniques to be overcome, enabling a complete diagnostic protocol and/or a minimally invasive surgical procedure. In malignant neoplasia, TEUS provided prognostic information for TNM grading. [ABSTRACT FROM AUTHOR]

Background: Body mass index is associated with the risk of Barrett's oesophagus (BO). It is uncertain whether this is related to total body fat or other factors that correlate with body mass index. We aimed to quantify the association between total body fat (measured by bioelectrical impedance) and risk of BO and examine if this association was modified by gastro-oesophageal reflux (GOR) and abdominal obesity. Methods: In 2007-2009, we surveyed 235 cases (69% Males, Mean age 62.1 years) and 244 age and sex matched population controls from a population based case-control study of BO. We conducted structured interviews, standard anthropometry and bioimpedance analysis of total body fat. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression analysis. Results: There was a significantly increased risk of BO among those in the highest tertile of total body fat weight (OR 2.01; 95%CI 1.26-3.21) and total body fat percentage (OR 1.86; 95%CI 1.10-3.15). These risks were largely attenuated after adjustment for GOR and waist circumference. There was a significantly increased risk of BO among those in the highest tertile of waist circumference (OR 2.21; 95%CI 1.39-3.51) and this was minimally attenuated after adjustment for total body fat and moderately attenuated after adjustment for GOR. Conclusions: Total body fat is associated with an increased risk of BO but this appears to be mediated via both abdominal obesity and GOR. These findings provide evidence that abdominal obesity is more important than total body fat in the development of BO. [ABSTRACT FROM AUTHOR]

Abstract: Gastroesophageal cancers comprising gastric cancer (GC), and cancers of the distal oesophagus and gastroesophageal junction (GEJ) are a global health threat. In Western populations the incidence of GC is declining which has been attributed to effective strategies of eradicating Helicobacter pylori infection. To the contrary, GEJ cancers are on the rise, with obesity and reflux disease being viewed as major risk factors. During the past decade perioperative chemotherapy, pre- or postoperative radio-chemotherapy, and, in Asian populations, adjuvant chemotherapy have been shown to improve the outcome of patients with advanced GC and GEJ cancers suited for surgery. Less progress has been made in the treatment of metastatic disease. The introduction of trastuzumab in combination with platinum/fluoropyrimidine-based chemotherapy for patients with HER2-positive disease has marked a turning point. Recently, several novel agents targeting growth factor receptors, angiogenic pathways, adhesion molecules and mediators of intracellular signal transduction have been clinically explored. Here we summarise the current status and future developments of molecularly targeted therapies in GC and GEJ cancer. [Copyright &y& Elsevier]

Background: Three Brown Swiss cows with abnormal regurgitation because of a perioesophageal disorder are described. Case presentation: The cows were ill and had poor appetite, salivation and regurgitation of poorly-chewed feed. Collection of rumen juice was successful in one cow, and in another, the tube could be advanced to the level of the 7th intercostal space, and in the third, only saliva could be collected. In one cow, oesophagoscopy revealed a discoloured 10-cm mucosal area with fibrin deposits. Thoracic radiographs were normal. The cows were euthanased and examined postmortem. Cow 1 had a large perioesophageal abscess containing feed material at the level of the thoracic inlet, believed to be the result of a healed oesophageal injury. Cow 2 had an abscess between the oesophagus and trachea 25 cm caudal to the epiglottis with the same presumed aetiology as in cow 1. Cow 3 had a mediastinal carcinoma that enclosed and constricted the oesophagus. Conclusions: Abnormal regurgitation in cattle is usually the result of an oesophageal disorder. Causes of oesophageal disorders vary widely and their identification can be difficult. [ABSTRACT FROM AUTHOR]

Aims In oesophageal adenocarcinoma, detection rates of venous invasion using haematoxylin and eosin (H&E) and elastic stains have not been compared. The aims of this study were to investigate whether or not elastic stains facilitate the detection of venous invasion, and to determine the prognostic significance of venous invasion following review with elastic stains. Methods and results One hundred and three resection specimens containing oesophageal adenocarcinoma, all reported originally as negative for venous invasion, were examined for the presence of venous invasion using H&E and subsequently Movat pentachrome stains. Venous invasion was detected in eight cases with H&E and an additional 66 cases using Movat pentachrome; overall, 72% of cases contained venous invasion. Venous invasion was associated with advanced stage, tumour size, lymphatic and perineural invasion and subsequent distant metastases. Venous invasion, stage, size, grade, lymphatic invasion and perineural invasion were prognostically significant on univariate analysis. Only tumour stage was independently prognostic. Two of eight patients with venous invasion but no other indication for adjuvant treatment died of recurrent disease. Conclusions Elastic stains improve detection of venous invasion significantly in oesophageal adenocarcinoma. Venous invasion is associated with multiple adverse clinicopathological features. Its identification may facilitate the stratification of patients at risk for visceral metastases and disease-related death. [ABSTRACT FROM AUTHOR]

OBJECTIVES The development of new therapeutic targets is needed to change the current low survival rates of cancer of the oesophagus. In some clinical trials, angiogenic inhibitors, including those targeting the vascular endothelial growth factor (VEGF) and its receptors, have proven efficacious. In concert with this, neuropilin-1 (NRP1), a coreceptor for VEGF, is expressed by many tumours and may be related to their progression. This study aimed to assess the expression and prognostic value of fNRP1 in primary squamous cell carcinoma (SCC) of the oesophagus. METHODS The expression of NRP1 receptors was assessed in 60 samples of resected oesophageal SCC and adjacent normal mucosa by western blotting, immunostaining and real-time quantitative PCR (qPCR). Furthermore, the relationship between NRP1 and the clinicopathological parameters was investigated. RESULTS NRP1 staining was limited within normal tissues of the oesophagus, while it was prominent in tumour cells and vasculature. Overexpression of NRP1 receptors (3.6 ± 0.48-folds) was apparent in 81.7% specimens (n = 60, P = 0.0001). qPCR consistently revealed parallel NRP1-mRNA overexpression (3.7 ± 3.7-folds) (n = 16, P = 0.02). A higher molecular weight-modified NRP1 (mNRP1) species was identified in a large proportion of the tumour specimens (85%), accounting for 71.51 ± 20.6% of their total NRP1. Overexpression of tumour NRP1 was positively correlated with deeper invasion into the oesophageal wall (P = 0.05) though mNRP1-positive tumour populations were significantly associated with less lymph node metastasis (P = 0.036) and better prognostic tumour-node-metastasis stage (P = 0.037) than mNRP1 negative tumours. CONCLUSIONS NRP1 overexpression in oesophageal SCC may contribute to local tumour invasiveness but the presence of the mNRP1 subtype correlates with less lymph node metastasis and better prognostic stage, suggesting that the balance between modified and unmodified NRP1 might be important for determining invasion potential. [ABSTRACT FROM PUBLISHER]

Abstract: A best evidence topic was written according to a structured protocol. The question addressed was: In patients undergoing oesophagectomy is stapled anastomosis (STA) superior to hand-sewn anastomosis (HSA) with respect to post-operative outcomes. In total, 82 papers were found suitable using the reported search and 14 of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing evidence shows that STA is associated with reduced time to anastomotic construction and decreased intra-operative blood loss but increased risk of benign stricture formation compared to HSA. There is no difference between HSA and STA with respect to cardiac or respiratory complications, anastomotic leakage, duration of hospital admission or 30-day mortality. In HSA, increasing surgical experience and intra-operative air leakage testing after anastomotic creation are associated with reduced risk of anastomotic leakage. Further adequately powered studies will enable identification of other local and systemic factors influencing anastomotic healing, which will lead to improved patient and anastomotic technique selection for optimal surgical outcomes. [Copyright &y& Elsevier]