上海市胸科医院胸外科食管功能检测已有30多年历史,是我国胸外科唯一拥有食管功能检测的科室。历经3代食管功能检测机器的更新换代,食管腔内24 h pH/阻抗监测可以协助诊断、治疗与之相关的食管良、恶性疾病。得益于食管功能检测,除了常...上海市胸科医院胸外科食管功能检测已有30多年历史,是我国胸外科唯一拥有食管功能检测的科室。历经3代食管功能检测机器的更新换代,食管腔内24 h pH/阻抗监测可以协助诊断、治疗与之相关的食管良、恶性疾病。得益于食管功能检测,除了常规的各类内镜下抗反流手术,上海市胸科医院近年来在国内率先开展系列针对食管良性疾病的工作及研究,如磁力环、双镜联合和抗反流内镜下新技术等,对疑因胃食管反流引起的间质性肺炎、肺纤维化患者行高分辨率食管测压及24 h pH/阻抗监测,评估患者胃食管反流与间质性肺炎、肺纤维化之间的相关性,为临床提供不同治疗依据甚至外科手术干预。美国使用Bravo胶囊较多,其对于传统测酸测压有明显优势。我们大力呼吁在这一领域开展产学研结合工作,开发具有自主知识产权的“本土制造”。展开更多
Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk fact...Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk factors remain elusive.This article comprehensively analyzed the global burden of GERD,shedding light on its risk factors,underlying pathophysiological mechanisms,current diagnostic modalities,evolving management strategies tailored to diverse patient profiles,and complex determinants contributing to treatment failures.A deeper comprehension of GERD is achieved by dissecting these intricate facets,paving the way for enhanced clinical management and improved patient outcomes.展开更多
Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to th...Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.展开更多
BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis ...BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.展开更多
Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniq...Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniques such as laparoscopic,thoracoscopic,and robotic-assisted approaches,MIE mini-mizes surgical trauma while maintaining oncological thoroughness.However,it also presents unique challenges,including risks of complications such as ana-stomotic leakage,pulmonary complications,and atrial fibrillation.Zhong et al developed and validated a risk stratification model for predicting surgical adverse events after MIE,enhancing preoperative assessment and patient management.This editorial further examines the advantages of MIE,its comparable oncological and long-term outcomes,as well as the incidence and contributing factors of post-operative complications.Emerging technologies,including machine learning models,intraoperative nerve monitoring,and robotic-assisted surgery,are high-lighted as innovative solutions for risk prediction and prevention.Strategies such as enhanced recovery after surgery protocols and multidisciplinary collaboration are emphasized for their critical roles in minimizing complications and optimizing patient outcomes.By addressing these aspects,this editorial provides guidance to surgical teams in maximizing the benefits of MIE while effectively managing its associated risks.展开更多
BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an altern...BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an alternative approach for the endoscopic removal of a large,irregular,and sharp foreign body(chicken bone)when traditional protective devices are inadequate,thus contributing to the management of such ingestions.CASE SUMMARY A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone.Emergent endoscopy showed it was tightly embedded in the esophageal wall,with minor bleeding.The chicken bone was grasped and moved cautiously using a foreign forceps.It was loosened after repeated attempts but could not pass through the pharynx.Considering possible mucosal damage,it was carefully pushed into the stomach cavity and then wrapped in a condom.The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps.No additional damage was found,except for primary esophageal injuries caused by the embedded chicken bone.The patient was discharged on the following day.Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.CONCLUSION Condoms can serve as an alternative when traditional protective devices are unsuitable.Because of its smooth and oily nature,it can provide mucosal protection and lubrication during endoscopic removal.展开更多
文摘上海市胸科医院胸外科食管功能检测已有30多年历史,是我国胸外科唯一拥有食管功能检测的科室。历经3代食管功能检测机器的更新换代,食管腔内24 h pH/阻抗监测可以协助诊断、治疗与之相关的食管良、恶性疾病。得益于食管功能检测,除了常规的各类内镜下抗反流手术,上海市胸科医院近年来在国内率先开展系列针对食管良性疾病的工作及研究,如磁力环、双镜联合和抗反流内镜下新技术等,对疑因胃食管反流引起的间质性肺炎、肺纤维化患者行高分辨率食管测压及24 h pH/阻抗监测,评估患者胃食管反流与间质性肺炎、肺纤维化之间的相关性,为临床提供不同治疗依据甚至外科手术干预。美国使用Bravo胶囊较多,其对于传统测酸测压有明显优势。我们大力呼吁在这一领域开展产学研结合工作,开发具有自主知识产权的“本土制造”。
文摘Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk factors remain elusive.This article comprehensively analyzed the global burden of GERD,shedding light on its risk factors,underlying pathophysiological mechanisms,current diagnostic modalities,evolving management strategies tailored to diverse patient profiles,and complex determinants contributing to treatment failures.A deeper comprehension of GERD is achieved by dissecting these intricate facets,paving the way for enhanced clinical management and improved patient outcomes.
文摘Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.
基金Supported by Guangzhou Municipal Science and Technology Bureau,No.SL2024AD3JD0112.
文摘BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.
文摘Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniques such as laparoscopic,thoracoscopic,and robotic-assisted approaches,MIE mini-mizes surgical trauma while maintaining oncological thoroughness.However,it also presents unique challenges,including risks of complications such as ana-stomotic leakage,pulmonary complications,and atrial fibrillation.Zhong et al developed and validated a risk stratification model for predicting surgical adverse events after MIE,enhancing preoperative assessment and patient management.This editorial further examines the advantages of MIE,its comparable oncological and long-term outcomes,as well as the incidence and contributing factors of post-operative complications.Emerging technologies,including machine learning models,intraoperative nerve monitoring,and robotic-assisted surgery,are high-lighted as innovative solutions for risk prediction and prevention.Strategies such as enhanced recovery after surgery protocols and multidisciplinary collaboration are emphasized for their critical roles in minimizing complications and optimizing patient outcomes.By addressing these aspects,this editorial provides guidance to surgical teams in maximizing the benefits of MIE while effectively managing its associated risks.
文摘BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an alternative approach for the endoscopic removal of a large,irregular,and sharp foreign body(chicken bone)when traditional protective devices are inadequate,thus contributing to the management of such ingestions.CASE SUMMARY A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone.Emergent endoscopy showed it was tightly embedded in the esophageal wall,with minor bleeding.The chicken bone was grasped and moved cautiously using a foreign forceps.It was loosened after repeated attempts but could not pass through the pharynx.Considering possible mucosal damage,it was carefully pushed into the stomach cavity and then wrapped in a condom.The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps.No additional damage was found,except for primary esophageal injuries caused by the embedded chicken bone.The patient was discharged on the following day.Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.CONCLUSION Condoms can serve as an alternative when traditional protective devices are unsuitable.Because of its smooth and oily nature,it can provide mucosal protection and lubrication during endoscopic removal.
