INTERNATIONAL SOCIETY FOR DISEASES OF THE ESOPHAGUS
Neoadjuvant radiochemotherapy based on the CROSS regimen is now widely adopted as the standard of care for esophageal cancer; with this regimen nearly half of patients with squamous cell carcinoma and 20% to 30% of patients with adenocarcinoma will have a complete pathological response (pCR), raising the question if an esophageal resection is still indicated in such patients. The article “Active surveillance in clinically complete responders after neoadjuvant chemoradiotherapy for esophageal or junctional cancer”1 reviews the current literature on this topic: four retrospective studies only were individuated, all of them consistently showing that the survival rate did not differ after clinical CR between those operated on and those left in an active surveillance program. However, the majority of patients who did not received surgery were unfit or refused it. Two RCTs (ESOSTRATE in France and SANO –Surgery As Needed for Oesophageal cancer- have now been initiated and both expect reseults in 2023.
1. Noordman BJ, Wijnhoven BPL, Lagarde SM, Biermann K et al. Diseases of The Esophagus 2017; December Issue
Read the full abstract here
How to manage an esophageal leak due to spontaneous (Boherhave) or iatrogenic perforation or after esophageal anastomosis remains a controversial topic. In this article “Outcome following the main treatment options in patients with a leaking esophagus: a systematic literature review”2 the Authors perform a systematic review to compare the two most used treatments: insertion of a self expandable metal stent and surgical repair. From 2005 to 2015 they selected 17 articles for a total of 371 patients treated with SEMS and 368 treated with direct or reinforced suture. The success rate was similar (88% vs 83%) with an in-hospital mortality of 7.5% for SEMS and 17% for surgery, suggesting that SEMS could be safely used to seal an esophageal leak, provided that less than48 hours elapsed from the leak and the positioning of the stent.
2. Persson S, Fouvelais I, Irino T, Lundell L. Diseases of the Esophagus 2017; December Issue
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The influence of physical activity on gastro-esophageal reflux disease (GERD), Barrett’s esophagus and adenocarcinoma have been scarcely investigated. Physical activity may play an important role in reducing the risk of esophageal adenocarcinoma with different pathways, including reducing the BMI, affecting patient lifestyle (consuming healthier food, reducing consumption of alcohol) and having a direct effect on the gastrointestinal system (vigorous exercise decreases the splanchnic blood flow and delays gastric emptying). The results of this meta-analysis based on three case-control studies with 10200 symptomatic GERD patients identified among 78034 participants showed that a moderate exercise has a protective effect on GERD symptoms. The only study on Barretts did not show any association with exercise and the few studies on adenocarcinoma reported a low, but statistically significant protective effect of moderate exercise for adenocarcinoma, even after adjusting for BMI.
The Authors finally suggested a possible U-shaped association of physical activity and the risk of GERD, Barretts and Adenocarcinoma, where moderate levels are protective but high levels are hazardous.
Read more here.
The Editors recommend:
Whole greater than the parts: integrated esophageal centers (IEC) and advanced training in esophageal diseases
By G. Triadafilopoulos
The management of esophageal diseases is becoming increasingly complex with new diagnostic, endoscopic and surgical techniques for both malignant and benign diseases. To handle this complexity and to streamline the patient pathway Dr. Triadafilapoulos proposes the creation of Integrated Esophageal Centers where all the expertise needed to treat esophageal diseases are gathered, including endoscopists, physiologists, surgeons, radiologists and pathologists. These integrated centers should have also educational commitments supporting clinical rotations and advanced esophageal fellowships in esophageal diseases for gastroenterologists and surgeons.
read more here
The Peer Review Week starts on Monday, September 11 – DOTE proudly announces the top 3 reviewers!
The Peer Review Week 2017 celebrates the essential role that peer review plays in maintaining scientific quality. The official ISDE journal #DOTE is thrilled to announce its top 3 reviewers:
Find out more about the reviewers visiting the DOTE website or follow us on Twitter and Facebook to stay up to date with Diseases of the Esophagus.
Nosy what the Peer Review Week 2017 is? Find out more here.
Diseases of the Esophagus introduces two AWARDS:
2017/2018 Best Junior Faculty/Trainee Manuscript Award
2017/2018 Junior Faculty Peer Reviewer Award
Click on the Award for detailed information.
The DOTE Editors-in-Chief Giovanni Zaninotto and Neil Gupta invite you to submit your application now!
ISDE is pleased to announce the new partnership with Oxford University Press to publish its monthly scientific journal Diseases of the Esophagus DOTE https://eurekalert.org/e/7h83
Diseases of the Esophagus is owned by the ISDE. At the completion of its 5-year contract with Wiley, the ISDE Executive Committee negotiated a new contract with Oxford University Press (OUP), who will publish the journal for the next 5 years. OUP is a well-renowned medical publisher dating back to the 17th century, when it published the leading best seller in the history of publishing: the King James Bible. OUP employs over 6,000 people with over 50 offices spread around the world. They publish over 350 journals with over 50% of its titles belonging to the top ranking quartile of journals. As you probably noticed, the last three issues of the journal had twice the number of its usual complement of pages. Thanks to an agreement between Wiley and OUP, we decided to temporarily increase the number of pages to substantially reduce the backlog of accepted, but unpublished manuscripts that had been accumulating over the years. One of our many aims is to reduce the time between the online publication of a manuscript and its effective publication to less than 3 months.
Read more here.
Dr. Neil Gupta is the new medical editor in chief of DOTE. He is a gastroenterologist at Loyola University Health System in Chicago, IL, where he serves as Co-Director of the Digestive Health Program and Director of Interventional Endoscopy. Dr. Gupta is young, bright, and enthusiastic. He will bring new ideas and projects to the journal to help us continue to improve its Impact Factor, the submission and review process for authors, time to publication, and access to journal content for readers. In addition, we will be expanding the journal's online presence through social media (such as Facebook and Twitter) and creating new content for publication (including high-quality review articles from international experts, ISDE guidelines, and multimedia/video content).
The October-November issue of Diseases of the Esophagus contains the first three articles dedicated to the analysis of the data gathered by the Worldwide Esophageal Cancer Collaboration (WECC) lead by Prof. Thomas Rice, that will form the basis for the new (8th) edition of the UICC- AJC TNM classification.
Data from more than 22,000 patients with staged esophageal cancer from 33 institutions in six continents were analyzed. Each institution submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all causes mortalities from the first management decision. Clinical data, pathological data, and pathological data in patients that received neoadjuvant chemo or chemoradiotherapy were separately addressed. One of the most relevant finding of this analysis is the need for a separate classification for pathological stage in patients operated with or without neoadjuvant therapy.
Go to DOTE - Vol 29 / Issue 7
Traditionally we used to measure the LES generated pressure, either during resting or at swallowing, by means of water perfused catheter or solid state sensors. With modern High Resolution Manometry, the LES generated pressures are measured in several points few mm apart. The function of LES is inferred by calculating its pressure and the length on whom this pressure is exerted and how it alters after swallowing.
Two articles in the current issue of Diseases of the Esophagus deal with a new tool (Endoflip) that allows to calculate the force needed to open the LES (LES distensibility). In the first, A. Ilczyszyn, K. Hamaoui, J. Cartwright and A. Botha, discuss the clinical utility of these measurements to optimize the myotomy in achalasia patients (Intraoperative distensibility measurement during laparoscopic Heller's myotomy for achalasia may reduce the myotomy length without compromising patient outcome, pages 455–462) and in the second, C. Lottrup, B. P. McMahon, P. Ejstrud, M. A. Ostapiuk, P. Funch-Jensen and A. M. Drewes present their finding on LES distensibility in a group of Hiatus hernia, Barretts and control patients. (Esophagogastric junction distensibility in hiatus hernia, pages 463–471) .
© International Society for Diseases of the Esophagus 2016