Syk Law

Appropriate timing for surgery after neoadjuvant chemoradiation for esophageal cancer.

Optimal interval between neoadjuvant chemoradiotherapy (CRT) and surgery is not elucidated for esophageal squamous carcinoma. The aim of this study is to evaluate the impact of this time interval on patient outcome. Patients treated with neoadjuvant CRT followed by surgery between 2002 and 2009 were analyzed. Patients were divided into two groups based on the median interval to surgery (64 days): A </= 64 days (n =xa054) and B >xa064 days (n =xa053). A second analysis was performed by re-classifying patients into three interval groups: A* ≤xa040 days (n =xa016); B* 41-80 days (n =xa060); C* >xa080 days (n =xa031). Operative outcome, pathological data, and long-term survival were analyzed. One hundred and seven (n =xa0107) patients were analyzed. Five patients (9.4%) in group B had an anastomotic leak compared with no leakage from group A (P <xa00.021). The complete pathological response was comparable in groups A and B (35% vs. 24.5%, p =xa00.23). R0 was significantly lower in group A* (A*: 56.3%, B*: 90%, C*: 74.2%, P =xa00.006). In patients with R0 resection, 5-year survival was significantly better in group A than B (71.7% vs. 51%, P =xa00.032) and in group A* (A* 100% vs. B* 60.2% & C* 48.3%; A* vs. B*, P =xa00.036; A* vs. C*, P =xa00.019). Complete pathological response was an independent predictor of survival. Early surgery with R0 resection following neoadjuvant CRT may lead to a better outcome. Further prospective studies are still necessary to provide better insight into the issue. At present, timing of surgery should be individualized and performed at the earliest opportunity.

Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review.

Spontaneous intramural esophageal dissection (IED) is a rare disease entity. There are few reports of spontaneous IED requiring surgical treatment. Hereby, we report a 37-year-old gentleman who was diagnosed to have spontaneous extensive circumferential IED complicated with esophageal perforation, empyema, and esophageal-pleural fistula. Esophageal stenting and drainage of empyema were unsuccessful. Computed tomography and gastrografin contrast swallow demonstrated a leak to the pleural cavity, suggestive of esophageal-pleural fistula. Subsequently, a two-stage operation was performed: cervical esophagogastrostomy to bypass the perforated esophagus, followed by esophagectomy and decortication of the right lung. The patient recovered and was discharged home after a 3-week hospitalization. The management principles and recent published literature related to IED were reviewed.

Modern results of esophagectomy for esophageal cancer: impacts of multimodality treatment and minimally invasive approach

Background: Brazilian population presents very high levels of genomic diversity due to the multi-ethnicity, which have important clinical/genomic implications. Cyclooxygenase-2 (Cox-2) is induced in response to growth factors and cytokines; and is expressed in infl ammatory diseases, premalignant and esophageal tumors. The product of folate metabolism by the enzyme methylenetetrahydrofolate reductase (MTHFR) acts in DNA synthesis. Alteration or inhibition of this enzyme increases the susceptibility to mutations, alter DNA methylation, and gene expression of the tumor suppressor genes and proto-oncogenes, leading to a potential risk factors for esophageal cancer. Cox-2 and MTHFR polymorphisms might modify the levels of protein expression and may have a considerable infl uence on disease phenotype, which may have important clinical/genomic implications.

Gastric conduit failure after esophagectomy: acute management and surgical reconstruction options

Background: Brazilian population presents very high levels of genomic diversity due to the multi-ethnicity, which have important clinical/genomic implications. Cyclooxygenase-2 (Cox-2) is induced in response to growth factors and cytokines; and is expressed in infl ammatory diseases, premalignant and esophageal tumors. The product of folate metabolism by the enzyme methylenetetrahydrofolate reductase (MTHFR) acts in DNA synthesis. Alteration or inhibition of this enzyme increases the susceptibility to mutations, alter DNA methylation, and gene expression of the tumor suppressor genes and proto-oncogenes, leading to a potential risk factors for esophageal cancer. Cox-2 and MTHFR polymorphisms might modify the levels of protein expression and may have a considerable infl uence on disease phenotype, which may have important clinical/genomic implications.

Treatment of gastric dysplasia and metaplasia by endoscopic radiofrequency ablation: a pilot study

a total of 29 treatment sessions were applied and 7 patients had completed 3 sessions of RFA. Six patients, including 2 patients with dysplasia, had completed their 12-month follow up endoscopy and3 patients had completed their 6-month follow up. Complete eradication of dysplasia was noted in both patients with LGD at baseline (100%). No patients with baseline metaplasia had complete eradication of IM but the severity of IM improved in 5 (62.5%) patients on follow up examination. The procedure was well tolerated with one patient demonstrating a minor mucosal laceration of the cricopharyngeus during insertion of the catheter. Conclusion: Radiofrequency ablation successfully eradicated low-grade dysplasia of the stomach. Although gastric IM persisted after RFA treatment, most patients had evidence of histological improvement on follow up examination. Key Word(s): 1. Gastric dysplasia; P0121 Esophageal, Gastric and Duodenal Disorders A study to draw a normative database of laryngopharynx pH profile in Chinese Presenting Author: GUIJIAN FENG Additional Authors: LIHONG ZHANG, YULAN LIU Corresponding Author: YULAN LIU Affiliations: Department of Gastroenterology, Peking University People’s Hospital; E.N.T,, Peking University People’s Hospital Objective: To draw a normative database of laryngopharynx pH profile in Chinese. Methods: Normal volunteers were recruited from “Ganji web” between May 2008 and Dec 2009. The Restech pH Probes were calibrated in pH 7 and pH 4 buffer solutions according to the manufacturer’s instructions. Each volunteer was asked to wear the device for a 24-hour period and was encouraged to participate in normal daily activities. Results: The healthy volunteers consisted of 20 males and 9 females with a median age of 23 years (interquartile range, 21 years-32 years). The 95th percentile for % total time pH < 4, pH < 4.5, pH < 5.0, pH < 5.5 for the oropharynx pH catheter were 0.06%, 0.42%, 7.23% and27.34%, respectively. The 95th percentile for number of reflux events for total pH < 4, pH < 4.5, pH < 5.0 and 5.5 were 2.0, 18, 107.5 and 284.5, respectively. Conclusion: This is the first study to systematically assess the degree of reflux detected by the new pH probe in healthy asymptomatic volunteers and report normative values in Chinese people. We only use the oropharyngeal pH cathete to ensure it can anlyse all LPR. At the same time, All the volunteers underwent scope, so the silent LPR patients were excluded. This study has systematically established normal values for the Restech pH system using oropharyngeal pH probes. Further studies are currently being performed to further validate this pH probe in patients with GERD and those with LPR to fully establish its role in diagnosis of this difficult to manage group of patients. Key Word(s): 1. Laryngopharyngeal; 2. reflux; 3. pH monitoring; P0122 Esophageal, Gastric and Duodenal Disorders Early gastric cancer: long term clinical study from a medical center in eastern Taiwan Presenting Author: LUCHIN HUANG Additional Authors: MING-CHE LEE, YUNG-HSIANG HSU Corresponding Author: LUCHIN HUANG Affiliations: Buddhist Tzu Chi General Hospital; Department of surgery, Buddhist Tzu Chi General Hospital; Department of pathology, Buddhist Tzu Chi General Hospital Objective: Early gastric cancer is defined as cancer that does not invade beyond the submucosa regardless of lymph node involvement. The eastern Taiwan is separated from the other areas of Taiwan by the Mountains Central. Aim: In order to investigate the manifestations of early gastric cancer, we performed this retrospective study. Methods: From August 1986 to March 2013, the patients who had received endoscopic examination, biopsy, surgical treatment, pathological examination and confirmed to be early gastric cancer were included. The age, gender, race, serum Poster Presentations 68 Journal of Gastroenterology and Hepatology 2013; 28 (Suppl. 3): 23–693