Tt 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.

Serum microRNA-193b as a promising biomarker for prediction of chemoradiation sensitivity in esophageal squamous cell carcinoma patients

Esophageal squamous cell carcinoma (ESCC) is the most predominantly occurring type of esophageal cancer worldwide. Locally advanced ESCC patients are treated by neoadjuvant chemoradiation for tumor downstaging prior to tumor resection. Patients receiving this treatment have an increased expectation of cure via the following tumor resection and have better survival outcomes. However, not all patients respond well to chemoradiation and poor responders suffer from treatment-associated toxicity and complications without benefits. No method is currently available to predict patient chemoradiation response and to exclude poor responders from ineffective treatment. To address this clinical limitation, the present study aimed to identify non-invasive biomarkers for predicting patient chemoradiation response. Due to the features of microRNA (miRNA) in cancer diagnosis, prognosis and treatment response prediction, serum miRNA arrays were performed to identify potential miRNA(s) that may be used for chemoradiation response prediction in ESCC. Using an miRNA array to compare pre-treatment serum sample pools from 10 good responders and 10 poor responders, the present study identified miR-193b, miR-942 and miR-629* as candidate miRNAs for predicting chemoradiation response. Subsequent validation using reverse transcription-quantitative polymerase chain reaction confirmed that miR-193b, however not miR-942 and miR-629*, were significantly increased in sera from 24 good responders, compared with 23 poor responders. Further analyses using the receiver operating characteristic curve revealed a strong predictive power of serum miR-193b on discriminating good responders from poor responders to chemoradiation. In addition, a high serum level of miR-193b was significantly associated with better survival outcomes. Therefore, serum miR-193b may be considered a promising biomarker for predicting chemoradiation response and post-therapy survival of ESCC patients.

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

INTRODUCTIONnThe mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment.nnnMETHODSnWe retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed.nnnRESULTSnWe identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaaves syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, <0.01, and <0.01, respectively).nnnCONCLUSIONSnMost oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.

Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: magnifying endoscopy findings.

Gastric mucosa-associated lymphoid tissue lymphoma is uncommon and most patients have an indolent clinical course. The clinical presentation and endoscopic findings can be subtle and diagnosis can be missed on white light endoscopy. Magnifying endoscopy may help identify the abnormal microstructural and microvascular patterns, and target biopsies can be performed. We describe herein the case of a 64-year-old woman with Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma diagnosed by screening magnification endoscopy. Helicobacter pylori-eradication therapy was given and she received biological therapy. She is in clinical remission after treatment. The use of magnification endoscopy in gastric mucosa-associated lymphoid tissue lymphoma and its management are 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.

Esophageal perforation: experience in 15 years

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