This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activat...This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activating DNA damage response(ATR/CHK1 and ATM/CHK2)pathways and downregulating telomere-binding proteins.Although its therapeutic potential is limited by poor aqueous solubility,solid dispersion(SD)technology may overcome this obstacle.Systematic analysis using PubChem-derived simplified molecular input line entry system identifiers and artificial intelligence-driven FormulationDT platform evaluation(oral formulation feasibility index:0.38)revealed that the SD technology,with superior scalability(32 approved products by 2021)and lower production risks,outperforms lipid-based formulations as an optimal dissolution strategy.Material analysis revealed hydroxypropyl methylcellulose(HPMC)as the optimal carrier with lower hygroscopicity,higher temperature and no intestinal targeting,thus enabling ESCC therapy.HPMC-based SD enhances BIBR1532 solubility and bioavailability for effective ESCC treatment.Future studies should focus on pilot tests for SD fabrication.展开更多
BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteri...BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.展开更多
Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submuco...Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.展开更多
BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,...BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.展开更多
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ...BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.展开更多
In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of tre...In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.展开更多
In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focu...In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.展开更多
This report presents the case of an 8.5-year-old boy with Down syndrome after experiencing extensive caustic injury to the oesophagus and stomach resulting from the accidental ingestion of concentrated sulphuric acid....This report presents the case of an 8.5-year-old boy with Down syndrome after experiencing extensive caustic injury to the oesophagus and stomach resulting from the accidental ingestion of concentrated sulphuric acid.The patient had undergone 32 unsuccessful endoscopic oesophageal stricture dilatations and stenting procedures performed over a period of 15 mo following the accident.Surgical reconstruction of the oesophagus was not possible due to previous gastric and cardiac surgeries for congenital conditions.Before referring the patient for salivary fistula surgery,the patient received a nasogastric tube with perforations located above the upper margin of the oesophageal stenosis for the passage of saliva and fluid.The tube was well tolerated and improved swallowing;however the backflow of gastric contents caused recurrent infections of the respiratory tract.To overcome these problems,we developed a double lumen,varying diameter,perforated tube for protection of the oesophageal closure.This nasogastric tube was found to be safe and decreased the need for hospitalization and further endoscopic procedures.This newly developed tube can thus be considered as a treatment option for patients with recurrent oesophageal stenosis and contraindications for surgical oesophageal reconstruction.展开更多
AIM:To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility(IOM;defined as ≥ 30% wet swallows with distal contractile amplitude < 30 mmHg) ,and to deter...AIM:To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility(IOM;defined as ≥ 30% wet swallows with distal contractile amplitude < 30 mmHg) ,and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets. METHODS:Clinical characteristics of manometric subsets were determined in 100 IOM patients(73 female,median age 58 years) and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms,but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter,and an ambulatory pH study assessed gastro-oesophageal reflux. RESULTS:Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions(LASC) experienced less heartburn(prevalence 26%) ,but more dysphagia(57%) than those in the IOM subset featuring low-amplitude propagated contractions(LAP;heartburn 70%,dysphagia 24%;both P ≤ 0.01) . LASC patients also experienced less heartburn and more dysphagia than patient controls(heartburn 68%,dysphagia 11%;both P < 0.001) . The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences(NT) was 54%(P = 0.04 vs LASC) and 36%(P < 0.01 vs controls) ,respectively. No differences inage and gender distribution,chest pain prevalence,acid exposure time(AET) and symptom/reflux association existed between IOM subsets,or between subsets and controls. CONCLUSION:IOM patients with LASC exhibit a different symptom profile to those with LAP,but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets,which warrants further investigation.展开更多
AIM To compare prognostic relevance of postoperative tumour/node/metastasis(TMN) stages between patients with and without neoadjuvant treatment. METHODS Data from patients with adenocarcinoma of the gastrooesophageal ...AIM To compare prognostic relevance of postoperative tumour/node/metastasis(TMN) stages between patients with and without neoadjuvant treatment. METHODS Data from patients with adenocarcinoma of the gastrooesophageal junction(AEG) who had undergone surgical resection at a single German university centre were retrospectively analysed. Patients with or without neoadjuvant preoperative treatment were selected by exact matching based on preoperative staging. Standard assessment of preoperative(c)TNM stage was based on endoscopic ultrasound and computed tomography of the thorax and abdomen, according to the American Joint Committee on Cancer/Union for International Cancer Control classification system. Patients with cT1cN0cM0 and cT2cN0cM0 stages were excluded from the study, as these patients are generally not recommended for pretreatment. Longterm survival among the various postoperative TNM stages was compared between the groups of patients with or without neoadjuvant treatment. For statistical assessments, a P-value of ≤ 0.05 was considered significant.RESULTS The study included a total of 174 patients. The group of patients who had received preoperative neoadjuvant treatment included more cases of AEG(Siewert) type 1 carcinoma(P < 0.001), and consequently oesophagectomy was performed more frequently among these patients(P < 0.001). The two groups(with or without preoperative neoadjuvant treatment) had comparable preoperative T stages, but the group of patients with preoperative neoadjuvant treatment presented a higher rate of preoperative N-positive disease(P = 0.020). Overall long-term survival was not different between the two groups of patients according to tumours of different AEG classifications, receipt of oesophagectomy or gastrectomy, nor between patients with similar postoperative TNM stage, resection margin and grading. However, an improvement of long-term survival was found for patients with nodal down-staging after neoadjuvant therapy(P = 0.053).CONCLUSION The prognostic relevance of postoperative TNM stages is similar for AEG in patients with or without neoadjuvant preoperative treatment, but treatment-related nodal down-staging prognosticates longer-term survival.展开更多
AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model.
Oesophageal ulcers occur mainly as a result of gastrooesophageal reflux disease （GERD）. However, pillinduced oesophageal ulcers are a fairly common event. The lesion is mainly due to entrapment of the pill and/ or i...Oesophageal ulcers occur mainly as a result of gastrooesophageal reflux disease （GERD）. However, pillinduced oesophageal ulcers are a fairly common event. The lesion is mainly due to entrapment of the pill and/ or its chemical composition thereof. This case report describes an oesophageal mucosa ulcer occurred in a healthy 35-year old woman who had no previous history of oesophageal disorders and received homeopathic medication. The present case reveals that pill entrapment can occur even in the oesophagus of healthy young individuals and that oesophageal mucosal ulcer can be triggered by substances generally thought devoid of any potentially mucosal aggressive effect.展开更多
<span><span style="white-space:nowrap;font-family:Verdana;"><strong>Background:</strong></span><strong><span style="font-family:Verdana;"></span><...<span><span style="white-space:nowrap;font-family:Verdana;"><strong>Background:</strong></span><strong><span style="font-family:Verdana;"></span></strong></span><span>Perforation of the oesophagus is a serious condition. Most of them are iatrogenic and are associated with significant morbidity and mortality, especially with late diagnosis. </span><b><span style="font-family:Verdana;">Aim:</span></b><span style="font-family:Verdana;"> To prospectively analyse the results of the endoscopic management of iatrogenic perforations in oesophageal neoplasia, through the immediate insertion of a covered self-expanding prosthesis (CSES). </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Between 01.01.2006 and 12.30.2016, a series of 19 consecutive patients attended the Teaching Unit of Endoscopic Surgery of the Regional de Concepción Hospital, Chile, with the diagnosis of oesophageal neoplasia confirmed by biopsy were prospectively studied. All were subjected to a prior evaluation by the oncology team and subsequently referred for endoscopic palliative management of dysphagia. The average age was 77 ± 9.3 years, 8 (42.1%) were female and 11 (57.9%) were male. In 17 patients (89.5%) the stenosis compromised the oesophagus, in 2 (10.5%) the gastro-oesophageal junction, 16 had a squamous carcinoma (84.2%) and 3 an adenocarcinoma (15.8%). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Perforation was diagnosed during the procedure in 18 patients (94.7%) and in 1 (5.3%) 22 hours later. Follow-up was done for a minimum of 90 days or until death. The prostheses were inserted successfully in all cases. The immediate evolution was satisfactory in 12 patients (63.2%). In the rest (36.8%), 18 complications appeared. The most frequent were retrosternal pain, subcutaneous emphysema and fever. The early evolution was satisfactory in 12/19 cases (63.2%). Complication was evidenced in 7 (36.8%), the most frequent was retrosternal pain (36.8%). Fever occurred in 3 (15.8%), pleural effusion in 3 (15.8%) and mediastinitis in 2 of these. The prosthesis was kept in situ as a definitive palliation method for neoplas</span><span><span style="font-family:Verdana;">tic dysphagia. In 10 of the 18 cases that survived more than a month, there were late complications (55.6%), none of them associated with the perforation itself. The only death (5.3%) was due to an oesophagus-pleural fistula, associated with an early prosthetic migration. Recovery of the oral intake occurred, on average, at 3.7 days. The hospital stay averaged 9.6 days. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The use of CSES for the treatment of iatrogenic oesophageal perforations in the context of neoplasia, is a safe and effective method, with low morbidity, adequate recovery of the oral intake and prompt discharge from hospital.</span></span>展开更多
AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the Un...AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the United Kingdom.Patients with squamous high grade dysplasia(HGD)and early squamous cell carcinoma(ESCC)confined to the mucosa were treated.Visible lesions were removed by endoscopic mucosal resection(EMR)before RFA.Following initial RFA treatment,patients were followed up 3monthly.Residual flat dysplasia was treated with RFA until complete reversal dysplasia(CR-D)was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond.The main outcome measures were CR-D at 12 mo from start of treatment,long term durability,progression to cancer and adverse events.RESULTS:Twenty patients with squamous HGD/ESCC completed treatment protocol.Five patients(25%)had EMR before starting RFA treatment.CR-D was 50%at12 mo with a median of 1 RFA treatment,mean 1.5(range 1-3).Two further patients achieved CR-D with repeat RFA after this time.Eighty per cent with CR-D remain dysplasia free at latest biopsy,with median follow up 24 mo(IQR 17-54).Six of 20 patients(30%)progressed to invasive cancer at 1 year.Four patients(20%)required endoscopic dilatations for symptomatic structuring after treatment.Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient.The other 2 patients required only a single dilatation to achieve an adequate symptomatic response.One patient developed cancer during follow up after end of treatment protocol.CONCLUSION:The role of RFA in these patients re-mains unclear.In our series 50%patients responded at12 mo.These figures are lower than limited published data.展开更多
AIM： To assess quantitative endoscopic ultrasound （EUS）- guided elastography in the nodal staging of oesophago- gastric cancers.METHODS： This was a single tertiary centre study as- sessing 50 patients with establi...AIM： To assess quantitative endoscopic ultrasound （EUS）- guided elastography in the nodal staging of oesophago- gastric cancers.METHODS： This was a single tertiary centre study as- sessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy （FNAB） of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS charac- teristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.展开更多
AIM: To identify if methylene tetra-hydrofolatereductase (MTHFR) C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are ...AIM: To identify if methylene tetra-hydrofolatereductase (MTHFR) C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are linked with cancer risk.展开更多
AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control st...AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett's oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.展开更多
Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a res...Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence.We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways.There are many trials underway with the aim of improving survival in oesophageal cancer.Currently,phase 2 and 3 trials are focused on MAP kinase inhibition,either through inhibition of growth factor receptors or signal transducer proteins.In order to avoid tumor resistance,it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas.This may be achievable in the future with the advent of gene signatures and a combinatorial approach.展开更多
BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patie...BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance(potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessionswas 37.2 ± 14.9. Histopathological examination of the specimens showed that 85%of patients had evidence of chronic oesophagitis(group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia(group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients(2%)had mild squamous dysplasia(group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of postcorrosive oesophageal stricture.展开更多
BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some pat...BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some patients may however present with oligometastasis which can be treated with loco-regional therapy.AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.METHODS A systematic search of the literature was performed in Cochrance Library,MEDLINE and EMBASE databases from September 1950 to January 2019.Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.RESULTS A total of 14 publications were included,of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis.All included articles evaluated the specific outcomes of metastasis,management modality and survival outcomes.The majority of the patients presented with oesophageal squamous cell carcinoma.The median disease free interval(time to recurrence)in patients was 19.6 mo and the overall survival reached 30.8 months.Unfavourable prognostic factors were assessed in eight studies and included time to recurrence<12 mo,large diameter pulmonary lesions(>20 mm),disease free interval(DFI)<12 mo,extra-pulmonary metastasis,primary tumour pathological stage III/IV.CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to locoregional treatment,and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.展开更多
基金Supported by“Continuation”Project of Excellent Doctors,Guangdong Basic and Applied Basic Research Foundation,No.2025A04J5082Guangdong Basic and Applied Basic Research Foundation,No.2024A1515011236.
文摘This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activating DNA damage response(ATR/CHK1 and ATM/CHK2)pathways and downregulating telomere-binding proteins.Although its therapeutic potential is limited by poor aqueous solubility,solid dispersion(SD)technology may overcome this obstacle.Systematic analysis using PubChem-derived simplified molecular input line entry system identifiers and artificial intelligence-driven FormulationDT platform evaluation(oral formulation feasibility index:0.38)revealed that the SD technology,with superior scalability(32 approved products by 2021)and lower production risks,outperforms lipid-based formulations as an optimal dissolution strategy.Material analysis revealed hydroxypropyl methylcellulose(HPMC)as the optimal carrier with lower hygroscopicity,higher temperature and no intestinal targeting,thus enabling ESCC therapy.HPMC-based SD enhances BIBR1532 solubility and bioavailability for effective ESCC treatment.Future studies should focus on pilot tests for SD fabrication.
基金Supported by National Natural Science Foundation of China,No.82002515,No.82273025 and No.82203460China Postdoctoral Science Foundation,No.2022TQ0070 and No.2022M710759Shanghai Municipal Commission of Science and Technology,No.22JC1403003,No.22XD1402200,No.19140901902 and No.22S31903800.
文摘BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.
文摘Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.
文摘BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2024MSXM065.
文摘BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
文摘In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.
文摘In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.
文摘This report presents the case of an 8.5-year-old boy with Down syndrome after experiencing extensive caustic injury to the oesophagus and stomach resulting from the accidental ingestion of concentrated sulphuric acid.The patient had undergone 32 unsuccessful endoscopic oesophageal stricture dilatations and stenting procedures performed over a period of 15 mo following the accident.Surgical reconstruction of the oesophagus was not possible due to previous gastric and cardiac surgeries for congenital conditions.Before referring the patient for salivary fistula surgery,the patient received a nasogastric tube with perforations located above the upper margin of the oesophageal stenosis for the passage of saliva and fluid.The tube was well tolerated and improved swallowing;however the backflow of gastric contents caused recurrent infections of the respiratory tract.To overcome these problems,we developed a double lumen,varying diameter,perforated tube for protection of the oesophageal closure.This nasogastric tube was found to be safe and decreased the need for hospitalization and further endoscopic procedures.This newly developed tube can thus be considered as a treatment option for patients with recurrent oesophageal stenosis and contraindications for surgical oesophageal reconstruction.
文摘AIM:To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility(IOM;defined as ≥ 30% wet swallows with distal contractile amplitude < 30 mmHg) ,and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets. METHODS:Clinical characteristics of manometric subsets were determined in 100 IOM patients(73 female,median age 58 years) and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms,but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter,and an ambulatory pH study assessed gastro-oesophageal reflux. RESULTS:Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions(LASC) experienced less heartburn(prevalence 26%) ,but more dysphagia(57%) than those in the IOM subset featuring low-amplitude propagated contractions(LAP;heartburn 70%,dysphagia 24%;both P ≤ 0.01) . LASC patients also experienced less heartburn and more dysphagia than patient controls(heartburn 68%,dysphagia 11%;both P < 0.001) . The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences(NT) was 54%(P = 0.04 vs LASC) and 36%(P < 0.01 vs controls) ,respectively. No differences inage and gender distribution,chest pain prevalence,acid exposure time(AET) and symptom/reflux association existed between IOM subsets,or between subsets and controls. CONCLUSION:IOM patients with LASC exhibit a different symptom profile to those with LAP,but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets,which warrants further investigation.
基金Supported by Land Schleswig-Holstein within the funding programme Open Access Publikationsfonds
文摘AIM To compare prognostic relevance of postoperative tumour/node/metastasis(TMN) stages between patients with and without neoadjuvant treatment. METHODS Data from patients with adenocarcinoma of the gastrooesophageal junction(AEG) who had undergone surgical resection at a single German university centre were retrospectively analysed. Patients with or without neoadjuvant preoperative treatment were selected by exact matching based on preoperative staging. Standard assessment of preoperative(c)TNM stage was based on endoscopic ultrasound and computed tomography of the thorax and abdomen, according to the American Joint Committee on Cancer/Union for International Cancer Control classification system. Patients with cT1cN0cM0 and cT2cN0cM0 stages were excluded from the study, as these patients are generally not recommended for pretreatment. Longterm survival among the various postoperative TNM stages was compared between the groups of patients with or without neoadjuvant treatment. For statistical assessments, a P-value of ≤ 0.05 was considered significant.RESULTS The study included a total of 174 patients. The group of patients who had received preoperative neoadjuvant treatment included more cases of AEG(Siewert) type 1 carcinoma(P < 0.001), and consequently oesophagectomy was performed more frequently among these patients(P < 0.001). The two groups(with or without preoperative neoadjuvant treatment) had comparable preoperative T stages, but the group of patients with preoperative neoadjuvant treatment presented a higher rate of preoperative N-positive disease(P = 0.020). Overall long-term survival was not different between the two groups of patients according to tumours of different AEG classifications, receipt of oesophagectomy or gastrectomy, nor between patients with similar postoperative TNM stage, resection margin and grading. However, an improvement of long-term survival was found for patients with nodal down-staging after neoadjuvant therapy(P = 0.053).CONCLUSION The prognostic relevance of postoperative TNM stages is similar for AEG in patients with or without neoadjuvant preoperative treatment, but treatment-related nodal down-staging prognosticates longer-term survival.
文摘AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model.
文摘Oesophageal ulcers occur mainly as a result of gastrooesophageal reflux disease （GERD）. However, pillinduced oesophageal ulcers are a fairly common event. The lesion is mainly due to entrapment of the pill and/ or its chemical composition thereof. This case report describes an oesophageal mucosa ulcer occurred in a healthy 35-year old woman who had no previous history of oesophageal disorders and received homeopathic medication. The present case reveals that pill entrapment can occur even in the oesophagus of healthy young individuals and that oesophageal mucosal ulcer can be triggered by substances generally thought devoid of any potentially mucosal aggressive effect.
文摘<span><span style="white-space:nowrap;font-family:Verdana;"><strong>Background:</strong></span><strong><span style="font-family:Verdana;"></span></strong></span><span>Perforation of the oesophagus is a serious condition. Most of them are iatrogenic and are associated with significant morbidity and mortality, especially with late diagnosis. </span><b><span style="font-family:Verdana;">Aim:</span></b><span style="font-family:Verdana;"> To prospectively analyse the results of the endoscopic management of iatrogenic perforations in oesophageal neoplasia, through the immediate insertion of a covered self-expanding prosthesis (CSES). </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Between 01.01.2006 and 12.30.2016, a series of 19 consecutive patients attended the Teaching Unit of Endoscopic Surgery of the Regional de Concepción Hospital, Chile, with the diagnosis of oesophageal neoplasia confirmed by biopsy were prospectively studied. All were subjected to a prior evaluation by the oncology team and subsequently referred for endoscopic palliative management of dysphagia. The average age was 77 ± 9.3 years, 8 (42.1%) were female and 11 (57.9%) were male. In 17 patients (89.5%) the stenosis compromised the oesophagus, in 2 (10.5%) the gastro-oesophageal junction, 16 had a squamous carcinoma (84.2%) and 3 an adenocarcinoma (15.8%). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Perforation was diagnosed during the procedure in 18 patients (94.7%) and in 1 (5.3%) 22 hours later. Follow-up was done for a minimum of 90 days or until death. The prostheses were inserted successfully in all cases. The immediate evolution was satisfactory in 12 patients (63.2%). In the rest (36.8%), 18 complications appeared. The most frequent were retrosternal pain, subcutaneous emphysema and fever. The early evolution was satisfactory in 12/19 cases (63.2%). Complication was evidenced in 7 (36.8%), the most frequent was retrosternal pain (36.8%). Fever occurred in 3 (15.8%), pleural effusion in 3 (15.8%) and mediastinitis in 2 of these. The prosthesis was kept in situ as a definitive palliation method for neoplas</span><span><span style="font-family:Verdana;">tic dysphagia. In 10 of the 18 cases that survived more than a month, there were late complications (55.6%), none of them associated with the perforation itself. The only death (5.3%) was due to an oesophagus-pleural fistula, associated with an early prosthetic migration. Recovery of the oral intake occurred, on average, at 3.7 days. The hospital stay averaged 9.6 days. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The use of CSES for the treatment of iatrogenic oesophageal perforations in the context of neoplasia, is a safe and effective method, with low morbidity, adequate recovery of the oral intake and prompt discharge from hospital.</span></span>
基金Supported by The CRUK UCL Early Cancer Medicine CentreBARRX Medical Inc Grant Supported to Lovat LBCovidien plc to support research infrastructure
文摘AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the United Kingdom.Patients with squamous high grade dysplasia(HGD)and early squamous cell carcinoma(ESCC)confined to the mucosa were treated.Visible lesions were removed by endoscopic mucosal resection(EMR)before RFA.Following initial RFA treatment,patients were followed up 3monthly.Residual flat dysplasia was treated with RFA until complete reversal dysplasia(CR-D)was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond.The main outcome measures were CR-D at 12 mo from start of treatment,long term durability,progression to cancer and adverse events.RESULTS:Twenty patients with squamous HGD/ESCC completed treatment protocol.Five patients(25%)had EMR before starting RFA treatment.CR-D was 50%at12 mo with a median of 1 RFA treatment,mean 1.5(range 1-3).Two further patients achieved CR-D with repeat RFA after this time.Eighty per cent with CR-D remain dysplasia free at latest biopsy,with median follow up 24 mo(IQR 17-54).Six of 20 patients(30%)progressed to invasive cancer at 1 year.Four patients(20%)required endoscopic dilatations for symptomatic structuring after treatment.Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient.The other 2 patients required only a single dilatation to achieve an adequate symptomatic response.One patient developed cancer during follow up after end of treatment protocol.CONCLUSION:The role of RFA in these patients re-mains unclear.In our series 50%patients responded at12 mo.These figures are lower than limited published data.
文摘AIM： To assess quantitative endoscopic ultrasound （EUS）- guided elastography in the nodal staging of oesophago- gastric cancers.METHODS： This was a single tertiary centre study as- sessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy （FNAB） of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS charac- teristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.
基金Supported by Endowment funds of the Wrightington,Wigan and Leigh NHS Foundation TrustAng Y received support from Comprehensive Local Research Network of Greater Manchester and Cheshire,United Kingdom(flexibility and sustainability grant)
文摘AIM: To identify if methylene tetra-hydrofolatereductase (MTHFR) C677T polymorphisms are associated with oesophageal adenocarcnomas in a Caucasian population and to test whether folic acid and homocysteine levels are linked with cancer risk.
文摘AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett's oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.
基金Supported by UK National Institute of Health Research/Cancer Research Network (UK NIHR/UKCRN) and Research and Development Department of Wrightington Wigan and Leigh NHS Foundation Trust (to Ang YS)R Keld WrightingtonWigan and Leigh NHS Foundation Trust Cancer Therapy Fund(to Keld RR,in part)
文摘Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence.We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways.There are many trials underway with the aim of improving survival in oesophageal cancer.Currently,phase 2 and 3 trials are focused on MAP kinase inhibition,either through inhibition of growth factor receptors or signal transducer proteins.In order to avoid tumor resistance,it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas.This may be achievable in the future with the advent of gene signatures and a combinatorial approach.
文摘BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance(potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessionswas 37.2 ± 14.9. Histopathological examination of the specimens showed that 85%of patients had evidence of chronic oesophagitis(group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia(group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients(2%)had mild squamous dysplasia(group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of postcorrosive oesophageal stricture.
文摘BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some patients may however present with oligometastasis which can be treated with loco-regional therapy.AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.METHODS A systematic search of the literature was performed in Cochrance Library,MEDLINE and EMBASE databases from September 1950 to January 2019.Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.RESULTS A total of 14 publications were included,of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis.All included articles evaluated the specific outcomes of metastasis,management modality and survival outcomes.The majority of the patients presented with oesophageal squamous cell carcinoma.The median disease free interval(time to recurrence)in patients was 19.6 mo and the overall survival reached 30.8 months.Unfavourable prognostic factors were assessed in eight studies and included time to recurrence<12 mo,large diameter pulmonary lesions(>20 mm),disease free interval(DFI)<12 mo,extra-pulmonary metastasis,primary tumour pathological stage III/IV.CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to locoregional treatment,and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.
