Rate Of Esophagitis Research Articles

АССОЦИАЦИЯ СОСУДИСТЫХ КАЛЬЦИНАТОВ МОЛОЧНЫХ ЖЕЛЕЗ, ВЫЯВЛЯЕМЫХ ПРИ МАММОГРАФИИ, С ЗАБОЛЕВАНИЯМИ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА

Abstract. Introduction. Calcium deposits in the breast vessels can be related to the calcium absorption disturbances in the gastrointestinal tract. Aim is to assess the association of the gastrointestinal pathology risk in women with breast vascular calcifications found at mammography. Materials and Methods. We included 193 patients examined using mammography in 2018. They were then followed up to the year 2023 and divided into two groups: No-calcification group and detectable-calcification group. Gastrointestinal pathology was registered in patient medical records. Results and Discussion. In 2018, 66 (34.2%) patients had breast vascular calcifications. In the detectable-calcification group, the nonspecific intestinal motility disorders were observed two times more frequently compared to the no-calcification group (relative risk [RR]: 2.34; 95%, confidence interval [CL]: 1.04 – 5.38; p=0.037). On the contrary, in the no-calcification group the rate of both esophagitis and gastroesophageal reflux was 4 timed higher than in the detectable-calcification group (RR: 4.29; 95%, CI: 0.95 – 19.34, p=0.041). At the end of the follow-up, the gallbladder stones were found approximately 2 times more frequently in the detectable-calcification group (ОР=2.22; 95%, CI: 1.15 – 4.3; p=0.017). Conclusions. The detectable breast vascular calcifications were associated with the higher gallbladder stones risk during subsequent 6 years (RR: 4.8; 95%, CI: 1.55 – 14.92; р=0.003) compared to the no-calcification group (4.7% versus 19.2%). At the same time, we found no association of the detectable breast vascular calcifications with the risk of hepatic steatosis / nonalcoholic fatty liver disease, gastritis, gastro-duodenitis, hiatal hernia, or pancreatitis.

Correlation of the Endoscopic Esophagogastric Junction Integrity with Symptomatic GERD in Patients Undergoing Work-Up for Metabolic and Bariatric Surgery.

Gastroesophageal reflux disease (GERD) is a common adverse effect after metabolic and bariatric surgery (MBS). Identifying patients with preexisting GERD is critical for preoperative planning. The American Foregut Society (AFS) recently proposed a new endoscopic classification system for objective assessment of the esophagogastric junction (EGJ) integrity, building upon the Hill classification. Grade 1 represents an intact EGJ, while grades 2, 3, and 4 represent partial, moderate, and complete disruption of the ARB. Unlike Hill classification, the AFS classification includes objective measurement of hiatal axial length and aperture diameter. The study aimed to evaluate the ability of the AFS hiatus classification to predict GERD severity using symptom questionnaires. We performed a prospective study of obese patients who underwent endoscopy as work-up for MBS. The endoscopy was evaluated for esophagitis, Barrett's esophagus, and AFS grade. All patients were also surveyed preoperatively with the GERD-HRQL, GerdQ, and RSI. The correlation between AFS grades and questionnaire scores was analyzed using Spearman's test. A total of 393 patients were included in the study. There were 81% female, with a mean age of 36 ± 10.7years and a mean BMI of 41.7 ± 7.2kg/m2. The AFS grades were distributed as follows: 11 (2.8%) patients had grade 1; 137 (34.9%) had grade 2; 162 (41.2%) had grade 3; and 83 (21.1%) had grade 4. There was a positive but weak correlation between AFS grades and all scoring systems, including GERD-HRQL (r = 0.201), heartburn (r = 0.203), regurgitation (r = 0.212), RSI (r = 0.110), and GerdQ scores (r = 0.202). However, the proportion of patients with esophagitis increased progressively with increasing grades (0% in grade 1, 2.2% in grade 2, 9.9% in grade 3, and 32.5% in grade 4, p = 0.01). The AFS hiatus classification can stratify the population with obesity based on rate of esophagitis and symptom scores. This study supports the practical utility of the AFS classification as an adjunct in the detection of patients who are at risk for GERD after MBS. Further validation studies with pH testing are needed.

Mathematical model of the relationship between pH holding time and erosive esophagitis healing rates.

Effective suppression of gastric acid secretion promotes healing of erosive esophagitis. Treatment guidelines recommend proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs). Emerging evidence also supports potassium-competitive acid blockers (P-CABs). The aim was to construct a mathematical model to examine the relationship between pH holding time ratios (HTRs) and erosive esophagitis healing rates with H2RAs, PPIs and P-CABs. By literature search, we identified studies of H2RAs, PPIs or P-CABs that reported mean pH >4 HTRs at steady state (days 5-8) and erosive esophagitis healing rates after 4 and/or 8 weeks. We aggregated treatments by drug class and developed a non-linear, mixed-effects model to explore the relationship between pH >4 HTRs and healing rates. The pH dataset included 82 studies (4297 participants; 201 dosage arms); healing rate data came from 103 studies (43,417 patients; 196 treatment arms). P-CABs achieved the longest periods with intragastric pH >4, and the highest healing rates after 4 and 8 weeks. The predicted probabilities of achieving ≥90% healing rates at 8 weeks were 74.1% for P-CABs, 17.3% for PPIs and 0% for H2RAs. P-CABs provide the longest duration with intragastric pH >4 and, accordingly, the highest healing rates of erosive esophagitis.

Association of gastroesophageal junction laxity and gastroesophageal reflux disease.

Gastroesophageal reflux disease is a prevalent condition with significant clinical variability, complicating its evaluation and treatment. The gastroesophageal flap valve is a fundamental evaluation method, but have shown limitations in specificity and reliance on subjective endoscopists' experience. Recent insights suggest that gastroesophageal junction laxity may offer an objective and quantifiable measurement for the presence of gastroesophageal reflux disease. This retrospective study analyzed data from 401 patients who underwent comprehensive evaluations, including a symptom questionnaire, endoscopy, pH-impedance monitoring, high-resolution manometry, and treatment directions, between January 1, 2022 and October 31, 2023. Gastroesophageal junction laxity was assessed using a modified approach based on endoscopic image analysis, with the diameter of endoscope as reference to estimate the long diameter of the laxity ring. The independent association of gastroesophageal junction laxity with pathologic acid exposure, esophagitis, and hiatal hernia were assessed by adjusting with age and sex. The mean age was 44.5 ± 5.5years old, and 49.9% (200/401) were male. The most common symptoms (≥ 1 point) were acid regurgitation (333/401, 83.0%), heartburn (315/401, 78.6%), belching (278/401, 69.3%), bloating (241/401, 60.1%), and globus sensation (241/401, 60.1%). The gastroesophageal junction laxity was significantly associated with pathologic acid exposure, esophagitis, hiatal hernia, and lower esophageal sphincter resting pressure. Notably, with the increase in gastroesophageal junction laxity, the rates of pathologic acid exposure, esophagitis, and hiatal hernia increased gradually, the lower esophageal sphincter resting pressure decreased gradually. The gastroesophageal junction laxity was independent associated with pathologic acid exposure (OR = 2.33, 95%CI 1.77-3.07, p < 0.001), esophagitis (OR = 2.10, 95%CI 1.62-2.73, p < 0.001), and hiatal hernia (high-resolution manometry: OR = 3.39, 95%CI: 2.46-4.67, p < 0.001) (endoscopy: OR = 21.65, 95%CI 11.70-40.06, p < 0.001). The gastroesophageal junction laxity was significantly associated with the indicators of pathophysiology in gastroesophageal reflux disease.

Selective inner muscle layer myotomy is associated with lower pain and same clinical efficacy that full-thickness myotomy in patients treated by POEM for achalasia: A multicenter retrospective comparative analysis of 158 patients

IntroductionThe aim of this study was to compare the impact of the depth of myotomy (selective inner layer myotomy (SIM) vs. full-thickness myotomy (FTM)) on the outcome of patients treated with POEM for achalasia. MethodsThis was a retrospective, observational, conducted in two tertiary centers between October 2018 and September 2022. Patients were divided into two groups: SIM and FTM. The primary endpoint was clinical efficacy at 6 months, while secondary endpoints were postoperative criteria (such as pain, length of hospital stay, complications) and occurrence of gastroesophageal reflux disease (GERD) (esophagitis at 6 months, heartburn, and pH-metry). Results158 patients were included in the study (33 in the FTM group and 125 in the SIM group). The success rates at 6 and 12 months were similar in both groups, with 84 % and 70 % in the SIM group versus 90 % and 80 % in the FTM group, respectively (p = 0.57 and p = 0.74). However, more opioid analgesics were consumed in the FTM group compared to the SIM group (41% vs 21 %, p < 0.01). The length of hospitalization was longer in the FTM group than in the SIM group (2.17 ± 2.62 vs 2.94 ± 2.33, p < 0.001). The rate of esophagitis at 6 months was comparable (16 % in the SIM group vs 12 % in the FTM group, p = 0.73). There was no significant difference in terms of heartburn at 6 or 12 months between the SIM and FTM groups (18.5% vs 3.8 %, p = 0.07 and 27% vs 12.5 %, p = 0.35, respectively). ConclusionThere was no significant difference in terms of clinical efficacy and GERD occurrence between FTM and SIM. However, full-thickness myotomy was associated with more postoperative pain and a longer length of hospital stay. Therefore, selective internal myotomy should be preferred over full-thickness myotomy.

Feasibility and safety of peroral endoscopic myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis.

Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia. We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled rates with 95% confidence intervals (CI) for outcomes were calculated using a random effect model. Heterogeneity was assessed using the I 2 statistic. We included 4 studies with 90 patients. Pooled rates (95%CI) of technical success and adverse events were 92% (83-96%) and 5% (2-11%), respectively. Pooled rates (95%CI) of esophagitis and wrap integrity on follow-up upper endoscopy were 18% (11-30%) and 85% (43-98%) respectively. Pooled mean procedure time and fundoplication time were 113.2 (98.7-127.6) and 55.3 (43.7-66.8) min, respectively. This meta-analysis demonstrates the feasibility and safety of POEM+F in patients with achalasia. More studies with long-term follow up are required to further validate these findings.

Evaluation of the frequency of hiatal hernia in patients undergoing upper gastrointestinal system endoscopy

Obesity was identified as an essential and independent risk factor for hiatal hernia. This study focused on the frequency of hiatal hernia detection in patients who underwent upper gastrointestinal system endoscopy in our clinic. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. This study examined the frequency of Hiatal hernia detection in 303 patients who underwent upper gastrointestinal endoscopy at our institution. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. Patient data were obtained from the hospital's electronic database. Age, gender, and upper gastrointestinal endoscopy reports were examined. The frequency of Hiatal hernia detection in patients who underwent upper gastrointestinal endoscopy was documented. According to the distribution of demographic and clinical findings of the patients, there was a statistically significant difference between the groups in terms of gender, age, waist circumference, and the occurrence of esophagitis (p&lt;0.05). The incidence of hiatal hernia was higher in men than in women, and the ages of patients with hernia were higher than those without. Waist circumferences and esophagitis rates of patients with hiatal hernias were higher than those without. As a result, obesity and body mass index (BMI) carry risks for hiatus hernia. In obese patients, Hiatal hernia should be included in the differential diagnosis of gastrointestinal complaints. The gold standard in the diagnosis of reflux is clinical and endoscopic examination.

Nazofarengeal Karsinom Tedavisinde Yoğunluk Ayarlı Radyoterapi ile Kombine Kemoterapinin Akut Yan Etkileri

Nasopharyngeal cancer is a very common head and neck cancer. Although concurrent chemotherapy plays an important role in controlling the disease, the risk of acute toxicity is high due to the anatomical location of the tumor. The aim of our study is to evaluate the acute side effects observed in nasopharyngeal carcinoma patients who underwent definitive chemoradiotherapy. A total of 64 patients (41 men, 23 women) between the ages of 20 and 82, who were diagnosed with nasopharyngeal cancer and treated, were included in the study. All patients received concurrent chemoradiotherapy along with intensity-modulated radiotherapy. While 70 Gy radiotherapy was applied to the tumor and positive lymph nodes, 60 Gy radiotherapy was applied to the entire nasopharynx and bilateral neck lymph nodes. Three cycles of cisplatin 100 mg/m2 (days 1, 22 and 43) or weekly 40 mg/m2 cisplatin chemotherapy were used for treatment. Acute side effects of the patients were noted and evaluated. Of the patients included in the study, 15 (23%) had stage II disease, 37 (58%) had stage III disease, and 12 (19%) had stage IV disease. The rates of grade 2 and 3 hematological toxicity in male patients were 47% and 20%, respectively. The rates of grade 2 and 3 hematological toxicity in male patients were 47% and 20%, respectively. A significant difference was found in the hematological toxicity rate between both groups (p= 0.0001). In patients under the age of 65, grade 2 and 3 hematological toxicity rates were determined as 47% and 20%, respectively. In patients over 65 years of age, the rates of grade 2 and 3 esophagitis were 53% and 80%, respectively. There was a significant difference in the rate of esophagitis between both groups (p= 0.0001). Our results are compatible with the literature in terms of acute side effects. Close monitoring and treatment of acute side effects can improve patient compliance with treatment, improve quality of life, and increase the effectiveness of treatment.

Does One-Anastomosis Gastric Bypass Expose Patients to GastroesophagealReflux: a Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophagealreflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Ygastric bypass.

Clinical outcomes of anti-reflux mucosal ablation for gastroesophageal reflux disease: An international bi-institutional study.

Anti-reflux mucosal ablation (ARMA) is an emerging endoscopic treatment aimed at enhancing the gastroesophageal junction flap valve. This study aimed to evaluate its feasibility, effectiveness, and safety. Between May 2018 and December 2022, patients with gastroesophageal reflux disease (GERD) symptoms refractory to acid suppression medications or those dependent on such medications were enrolled for ARMA. This retrospective analysis utilized prospectively collected data from an international bi-center study. GERD questionnaire, upper endoscopy, and 24-h pH monitoring were conducted at 2-6months and 12months post-ARMA. Clinical success was defined as a >50% reduction in a validated GERD questionnaire. A total of 68 patients underwent ARMA. Definitive GERD was diagnosed in 44 (64.7%) patients, while 24 (35.3%) exhibited reflux hypersensitivity. Clinical success rates at 2-6months and 1year post-ARMA were 60% (39/65) and 70% (21/30), respectively. The median GERD-health-related quality of life score significantly improved from 26 to 11 at 2-6months (P<0.001). Among the 51 patients (71.8%) who underwent 24-h pH monitoring, the median acid exposure time decreased from 5.3% to 0.7% (P=0.003), accompanied by a significant reduction in esophagitis rates (P<0.001). Multivariate analysis did not identify predictors of short-term success. Nine (13.2%) patients experienced transient stenosis requiring balloon dilation. ARMA demonstrates both technical feasibility and reproducibility as a safe procedure that effectively ameliorates GERD symptoms in approximately two-thirds of patients during short-term follow up. Both reflux hypersensitivity and confirmed GERD patients, regardless of their response to acid suppression medication, may be suitable candidates.

Risk of Esophagitis in Patients with Limited Stage SCLC Treated with QD or BID Chemoradiotherapy Regimens with Contralateral Esophagus Sparing

Recent randomized phase III trials in limited stage (LS) small cell lung carcinoma (SCLC) demonstrate persistent high rates of grade (G) ≥ 3 esophagitis of 16-19% for 45 Gy BID and 66-70 Gy QD radiotherapy (RT). G3 esophagitis dramatically impairs quality of life and is a barrier to treatment intensification. We previously developed a contralateral esophagus sparing technique (CEST) that reduced esophagitis mainly in patients with locally advanced NSCLC treated with chemoRT to 70 Gy/7 weeks. It is not established whether CEST is effective in LS-SCLC patients, especially those receiving BID RT which may limit mucosal esophageal regeneration during treatment. Here, we report our single-institution experience with this approach. We retrospectively analyzed the records of patients with LS-SCLC who received chemoRT between June 2014 and October 2022. Patients were treated with QD or BID schedules at physician discretion though QD has historically been favored at our institution. The esophageal wall contralateral to the tumor was contoured as an avoidance structure. IMRT or VMAT was used to drive steep dose fall-off across the esophagus while maintaining full tumor coverage. Daily cone-beam CT guidance was employed. Toxicity was assessed using CTCAE v5 criteria. Descriptive statistics were used to analyze outcomes. The study was approved by the IRB. We identified 38 consecutive patients with LS-SCLC treated with definitive chemoRT. Median age was 67 years, and 60.5% were female. Twenty-seven were treated with QD RT to a median dose of 63 Gy (range 55.8-70) in 33 fractions (range 31-35). All remaining patients received BID RT 45 Gy in 30 fractions. Median CTV for the QD and BID cohorts was 205 cc and 214 cc, respectively. Almost all patients (n = 37) had tumor located within 1 cm of the esophagus. There were no ≥G3 esophagitis events (95% CI, 0-9.3%). The rate of G2 esophagitis was 21.1% (11.1-36.3%), with no significant difference between QD (26%) and BID (9%) cohorts (p = 0.3). Only two patients required narcotics. For BID patients, CE planning constraints were scaled to reflect the shortened RT course. The median CE maximum dose, V20, and V30 were 44.8 Gy, 7.9 cc, and 6.4 cc, respectively. For the QD cohort, the median CE maximum dose, V45, and V55 were 59.5 Gy, 3.0 cc, and 0.6 cc, respectively. Treatment breaks occurred in nine QD patients due to neutropenia. Median follow-up was 31.0 months. 3-year overall survival was 70.0% (95% CI, 49.8-83.3%). While we are limited by small patient numbers and possible selection bias, our data suggest that CE sparing can be effective in LS-SCLC, with low severe esophagitis risk even for BID RT regimens. CEST is readily adaptable into clinical practice which should facilitate further refinement of empirically derived CE planning constraints.

Effect of Contralateral Esophagus Sparing in Hypofractionated Radiotherapy for Ultra-Central NSCLC

Esophageal toxicity is a known complication of radiotherapy (RT) for ultra-central lung tumors, with ∼5 - 15% of patients developing grade ≥3 esophagitis. Despite increasing adoption of hypofractionated regimens, there are no consensus recommendations for reducing esophageal toxicity in these patients. We previously demonstrated the utility of a novel contralateral esophagus sparing technique (CEST) in a prospective trial of patients with locally-advanced NSCLC receiving concurrent chemoRT (70 Gy/7 weeks). Whether CEST is effective for hypofractionated RT is unknown. The aims of this study were to identify outcomes and toxicities associated with use of CEST in patients receiving definitive hypofractionated RT to ultra-central lung tumors. We retrospectively analyzed the records of consecutive patients with ultra-central NSCLC who received definitive RT to a dose of ≥60 Gy with fraction size ≥3 Gy per day, from 1/1/2015 to 6/30/2022. The esophageal wall contralateral to the tumor was contoured as an avoidance structure. VMAT planning was used to ensure steep dose fall-off across the esophagus while maintaining full tumor coverage. Treatment was delivered using daily cone-beam CT guidance. Toxicity was graded using CTCAE v 4.0. Descriptive statistics were used to analyze outcomes. The study was approved by the IRB. We identified 45 patients with ultra-central NSCLC treated with definitive RT, with median follow-up of 27.3 months. Median age was 74.5 years old [57.6 - 88.2]. Median ECOG PS was 2 [1 - 3]. Twenty-three patients had PTVs located within 1 cm of the esophagus. Median ITV and PTV volumes were 17 cc [1.6 - 154 cc] and 43.6 cc [8.4 - 292 cc], respectively. Median total dose was 60 Gy [60 - 67.5 Gy] in 20 [10 - 20] fractions. Median esophageal Dmax was 24 Gy [2 - 66.7 Gy] for all patients and 36 Gy [12.3 - 66.7 Gy] for patients with tumors located within 1 cm of the esophagus. For the CE, median Dmax, V20 Gy and V25 Gy were 35.7 Gy [17 - 45.2 Gy], 2.1 cc [0 - 6.7 cc] and 0.95 cc [0 - 3 cc], respectively. There were no episodes of grade ≥2 esophagitis (95% CI, 0-7.9%). The rate of grade 1 esophagitis was 13.3% (6.2 - 26.1%). Esophageal Dmax was higher in patients who developed esophagitis (44.5 vs. 26.1 Gy, t = 2.5, p = 0.038). Two patients developed grade 2 pneumonitis (4.4%, 95% CI 0 - 10.5%). There were no episodes of grade ≥3 pulmonary toxicity. There were 3 (6.7%) local recurrences, with 2-year local recurrence rate of 4.4%. Use of CEST to minimize esophageal dose for treatment of ultra-central NSCLC is associated with reduced rates of esophagitis compared with historical controls, without compromising local control. This technique is readily adaptable for clinical practice. More data are needed to refine the empirically derived CE dose-volume constraints, especially for tumors directly abutting the esophagus.

Comparing Gastrointestinal Endoscopy Findings in Children with Autism, Developmental Delay, or Typical Development

To compare endoscopic and histologic upper endoscopy (esophagogastroduodenoscopy [EGD]) findings in children with autism spectrum disorders (ASD) to age- and gender-matched controls with developmental delay (DD) or with typical development (TD). Retrospective, cross-sectional study of children undergoing EGD, identifying those diagnosed with ASD, and matching on age and gender to children with DD or TD in ratio of 1:1:2. Rates of EGD findings were compared between the 3 groups using χ² or Fisher exact test. Multivariable linear regression was performed to identify predictors of abnormal histology. A total of 2104 patients were included (526 ASD; 526 DD; 1052 TD). Children with ASD had higher rates of abnormal esophageal histology (ASD 38.4%; DD 33.4%; TD 30.4%, P=.008), particularly esophagitis. In multivariable modeling, ASD diagnosis was an independent predictor of abnormal esophageal histology (OR [95% CI] 1.38 [1.09, 1.76]) compared with TD. Stomach findings did not differ among the groups. In the duodenum, histologic abnormalities were observed with lower frequency in ASD (ASD 17.0%; DD 20.1%; TD 24.2%, P=.005). In multivariable analysis, ASD diagnosis was not a significant predictor (OR 0.78 [0.56, 1.09]) of abnormal duodenal histology. Children with ASD have higher rates of histologic esophagitis compared with age- and gender-matched DD and TD controls. ASD was a significant independent predictor of abnormal esophageal, but not, duodenal, histology. These results underscore the importance of EGD in children with ASD.

Reflux and Barrett's esophagus after sleeve gastrectomy: analysis of a statewide database.

Recent studies have suggested that sleeve gastrectomy (SG) is associated with the development of Barrett esophagus (BE) even in the absence of gastroesophageal reflux disease (GERD) symptoms. The aim of this study was to assess the rates of upper endoscopy and incidence of new BE diagnoses in patients undergoing SG. This was a claims-data study of patients who underwent SG between 2012 and 2017 while enrolled in a U.S. statewide database. Diagnostic claims data were used to identify pre- and postoperative rates of upper endoscopy, GERD, reflux esophagitis, and BE. Time-to-event analysis using a Kaplan-Meier approach was performed to estimate the cumulative postoperative incidence of these conditions. We identified 5562 patients who underwent SG between 2012 and 2017. Of these, 1972 patients (35.5%) had at least 1 diagnostic record of upper endoscopy. The preoperative incidences of a diagnosis of GERD, esophagitis, and BE were 54.9%, 14.6%, and .9%, respectively. The predicted postoperative incidences of GERD, esophagitis, and BE, respectively, were 18%, 25.4%, and 1.6% at 2 years and 32.1%, 85.0%, and 6.4% at 5 years. In this large statewide database, rates of esophagogastroduodenoscopy remained low after SG, but the incidence of a new postoperative esophagitis or BE diagnosis in patients who underwent esophagogastroduodenoscopy was higher than in the general population. Patients undergoing SG may have a disproportionately high risk of developing reflux complications including BE after surgery.

Chemoradiotherapy Combined with Brachytherapy for the Definitive Treatment of Esophageal Carcinoma.

This study aims to investigate the effect of dose escalation with brachytherapy (BT) as an addition to definitive chemoradiotherapy (CRT) on local control and survival in esophageal cancer. From 2001 to 2020, 183 patients with locally limited or locally advanced esophageal cancer received definitive CRT with or without brachytherapy in a two-center study. External-beam radiotherapy was delivered at 50.4 Gy in 1.8 Gy daily fractions, followed by a sequential boost to the primary tumor of 9 Gy in 1.8 Gy daily fractions if indicated. Intraluminal high dose rate (HDR) Ir-192 brachytherapy was performed on 71 patients at 10 Gy in two fractions, with one fraction per week. The combined systemic therapy schedules used included 5-fluorouracil/cisplatin or 5-fluorouracil alone. Cisplatin was not administered in patients receiving brachytherapy. The median local progression-free survival was significantly extended in the BT group (18.7 vs. 6.0 months; p < 0.0001), and the median local control was also significantly prolonged (30.5 vs. 11.3 months, p = 0.008). Overall survival (OS) significantly increased in the BT group (median OS 22.7 vs. 9.1 months, p < 0.0001). No significant difference in the overall rate of acute toxicities was observed; however, the rate of acute esophagitis was significantly higher in the BT group (94.4% vs. 81.2%). Likewise, the overall rate of late toxicities (43.7% vs. 18.8%) was significantly higher in the BT group, including the rate of esophageal stenosis (22.5% vs. 9.8%). There was no difference in the occurrence of life-threatening or lethal late toxicities (grades 4 and 5). Brachytherapy, after chemoradiation with single-agent 5-FU, represents a safe and effective alternative for dose escalation in the definitive treatment of esophageal cancer.

Morbidity of single-fraction spine radiosurgery for metastatic disease.

e24116 Background: The optimal management of metastatic spine disease involves radiation therapy, with stereotactic radiosurgery (SRS) utilization having increased in adoption while proving to be efficacious and safe. Spine SRS morbidity (fatigue, dermatitis, nausea and esophagitis) is generally mild and depends on the spinal vertebral level(s) treated. More severe adverse events such as vertebral compression fracture (VCF), radiation-induced myelopathy, and tracheoesophageal (TE) fistula have been documented. The potential benefits of single-fraction SRS (sfSRS) over multi-fraction SRS include increased patient convenience, decreased financial toxicity, and increased treatment completion rates. These benefits may potentially be overshadowed by the morbidity of sfSRS versus multifraction SRS. In this analysis, we perform the first comprehensive examination of sfSRS morbidity in the treatment of spinal lesions. Methods: An extensive search of the PubMed database was undertaken through 2/2/23 to find studies examining spinal sfSRS. Search parameters included the terms “single-fraction, spine, radiation SRS OR SBRT” Articles including multi-fractionated regimens only, reviewed sites outside of the spine, or did not report on clinical outcomes/toxicities were excluded. Results: 17 articles met initial inclusion criteria; 9 were added from references for a total of 26 articles comprising at least 2,699 patients (one study reported the number of tumors, not patients). Dose ranges for single-fraction SRS were 8-26 Gy. Commonly noted toxicities were fatigue, nausea/vomiting, and dermatitis which were no worse than moderate/minimal, not requiring invasive intervention. The overall rate of VCF was 16.2%, with an increased propensity at &gt;20 Gy. The proportion of reported segments requiring surgical intervention (operative stabilization, vertebroplasty/kyphoplasty) for VCF after single-fraction SRS was 20.2% (33/163). The rate of TE fistula at 25 Gy was 8.3%, with an overall rate (dose range = 10-28 Gy) of 1.3% with up to 12-years of follow-up. In patients receiving median dose of 24 Gy, the rate of severe esophagitis was 6.8%, myositis was 1.3% (at 1-year) and 8.3% (at 5-years). The rate of peripheral nervous system injury was 2.5% (at 18-26 Gy) and pain flare was 8% (at 16-24 Gy). The rate of ureteral and esophageal stricture was 1.9% each in patients receiving 12-24 Gy. Conclusions: VCF is the most commonly reported severe adverse events with single-fraction spine SRS, particularly for doses &gt; 20 Gy. 80% of VCFs can be successfully managed without invasive intervention. Other severe adverse events are rare – particularly for &lt; 20 Gy – but require post-SRS monitoring to expediently and efficiently intervene if necessary. These findings indicate that single-fraction spine SRS to &lt; 20 Gy is safe with minimal morbidity. Further study regarding the efficacy of such dosing is being evaluated in ongoing clinical trials.

Microbial and epidemiological factors in early detection of esophageal squamous cell carcinoma and precancerous lesions.

Microbial and epidemiological factors in early detection of esophageal squamous cell carcinoma and precancerous lesions.

Effects of proximal gastrectomy with narrow gastric tube anastomosis compared with total gastrectomy with Roux-en-Y anastomosis on upper gastric cancer.

To investigate the clinical efficacy of proximal gastrectomy with narrow gastric tube anastomosis (PG-NGT) and total gastrectomy with Roux-en-Y anastomosis (TG-RY) for upper gastric cancer. One hundred sixty-three upper gastric cancer patients were enrolled into the PG-NGT group and TG-RY group. The propensity score matching method was used to conduct a one-to-one match between the two groups with 38 patients in each group. Compared with the TG-RY group, the PG-NGT group had significantly (P < 0.05) shorter operation time, shorter hospital stay, and less intraoperative blood loss. The TG-RY group had significantly (P = 0.009) more lymph nodes dissected and greater (P = 0.014) total cost than the PG-NGT group, but no significant difference existed in the surgical cost between the two groups (P = 0.214). There was no significant (P > 0.05) difference in the incidence of anastomotic stenosis (10.5% vs. 13.1%) or the reflux esophagitis rate (8.6% vs. 9.1%) in the PG-NGT group and the TG-RY group. One year after surgery, the weight and hemoglobin and albumin levels in the PG-NGT group were significantly (P < 0.05) higher than those in the TG-RY group. PG-NGT may be better than TG-RY in improving patient weight loss and hemoglobin and albumin levels, without increasing the rate of anastomotic stenosis and reflux symptoms.

High-risk patients with locally advanced non-small cell lung cancer treated with stereotactic body radiation therapy to the peripheral primary combined with conventionally fractionated volumetric arc therapy to the mediastinal lymph nodes.

A very narrow therapeutic window exists when delivering curative chemoradiotherapy for inoperable locally advanced non-small cell lung cancer (NSCLC), particularly when large distances exist between areas of gross disease in the thorax. In the present study, we hypothesize that a novel technique of stereotactic body radiation therapy (SBRT) to the primary tumor in combination with volumetric arc therapy (VMAT) to the mediastinal lymph nodes (MLN) is a suitable approach for high-risk patients with large volume geographically distant locally advanced NSCLC. In this single institutional review, we identified high-risk patients treated between 2014 and 2017 with SBRT to the parenchymal lung primary as well as VMAT to the involved MLN using conventional fractionation. Dosimetrically, comparative plans utilizing VMAT conventionally fractionated delivered to both the primary and MLN were analyzed. Clinically, toxicity (CTCAE version 5.0) and oncologic outcomes were analyzed in detail. A total of 21 patients were identified, 86% (n=18) of which received chemotherapy as a portion of their treatment. As treatment phase was between 2014 and 2017, none of the patients received consolidation immunotherapy. Target volume (PTV) dose coverage (99 vs. 87%) and CTV volume (307 vs. 441ml) were significantly improved with SBRT+MLN vs. for VMAT alone (p<0.0001). Moreover, low-dose lung (median V5Gy [%]: 71 vs. 77, p<0.0001), heart (median V5Gy [%]: 41 vs. 49, p<0.0001) and esophagus (median V30Gy [%]: 54 vs. 55, p=0.03) dose exposure were all significantly reduced with SBRT+MLN. In contrast, there was no difference observed in high-dose exposure of lungs, heart, and spinal cord. Following SBRT+MLN treatment, we identified only one case of high-grade pneumonitis. As expected, we observed a higher rate of esophagitis with a total of seven patients experience grade 2+ toxicity. Overall, there were no grade 4+ toxicities identified. After a median 3 years follow up, disease progression was observed in 70% of patients irradiated using SBRT+MLN, but never in the spared 'bridging' tissue between pulmonary SBRT and mediastinal VMAT. For high risk patients, SBRT+MLN is dosimetrically feasible and can provide an alternative to dose reductions necessitated by otherwise very large target volumes.

Incidence of Abnormalities of the Gastric Tube Following Sleeve Gastrectomy and Its Role on Esophagitis Progression.

The purpose of this study is to determine the incidence of gastric tube abnormalities after SG and its relationship with esophagitis progression. Retrospective study which included 459 patients in the postoperative period of SG who underwent an esophagogastroduodenoscopy in both pre- and postoperative periods. The main studied variables were presence of gastric tube abnormalities (dilation, neofundus, twist, and hiatal hernia) and esophagitis progression. Among the 459 patients who underwent SG, 393 (85.6%) were women, and 66 (14.4%) men, with mean age of 40.4years. Mean preoperative BMI was 39.70kg/m2. In total, 20.3% of the sample presented progression of esophagitis after surgery. Among the whole sample, 130 (28.3%) presented with an abnormality of the remnant gastric tube. The most common alteration was gastric dilation, which occurred in 16.1% of the patients, followed by gastric twist (10.7%), neofundus (7.4%), and hiatal hernia (0.2%). Patients who presented with any abnormality of the gastric tube were significantly prone to presenting esophagitis progression (p = 0.013). When analyzing each morphological abnormality isolated, there was no statistically significant correlation. Abnormalities of the gastric tube are not uncommon after SG and seems to contribute partially to the relevant rates of GERD and esophagitis after this surgery.