ABSTRACT
INTRODUCTION: A reproducible and simple model is essential for verifying gastric conduit vitality before esophagectomy. Ischemia is a major cause of esophagogastric anastomotic dehiscence and leakage. Ischemic conditioning of the stomach prior to esophageal surgery has been shown to lower the incidence of postoperative complications, including anastomotic leakage. However, the optimal timing and technique of ischemization remain uncertain. METHODS: Male Sprague-Dawley rats (n=24) were randomly divided into four groups: ischemic group - samples collected 1 hour after ischemia (I1H), ischemic group - samples collected 1 day after ischemia (I1D), ischemic group - samples collected 7 days after ischemia (I7D), and control group (C). Ischemia was induced by ligation of the left gastric (LGA) and short gastric arteries (SGA). The samples were verified using histological and macroscopic analysis, and the number and percentage of immunocompetent cells were determined. RESULTS: One hour after ischemization (I1H), ischemic denudation with mucosal erosion was observed, and the total number of eosinophils was significantly higher (p.
Subject(s)
Anastomosis, Surgical , Esophagectomy , Esophagus , Ischemic Preconditioning , Rats, Sprague-Dawley , Stomach , Animals , Ischemic Preconditioning/methods , Male , Rats , Esophagus/blood supply , Esophagus/surgery , Esophagus/pathology , Stomach/blood supply , Stomach/surgery , Stomach/pathology , Anastomotic Leak/prevention & control , Anastomotic Leak/etiologyABSTRACT
This case report describes the coexistence of a retroesophageal right subclavian artery and left maxillary artery which passed deep to the mandibular nerve. An 88-year-old woman died of acute heart failure, and the postmortem revealed that the right subclavian artery originated from the aortic arch as the last branch at the level of the fourth thoracic vertebra, then passed between the esophagus and the vertebral column. The artery then ascended right superiorly and passed behind the anterior scalene muscle. The right vertebral artery arose from the retroesophageal right subclavian artery and entered the transverse foramen of the sixth cervical vertebra. The left maxillary artery branched at the common trunk of the posterior deep temporal and the inferior alveolar arteries. The maxillary artery then turned anteromedially and branched to give the middle meningeal artery. The mandibular nerve gave off the buccal nerve, deep temporal nerve and a thick nerve just below the foramen ovale. The auriculotemporal nerve that branched from the thick nerve ran deep to the maxillary artery. The maxillary artery turned anteriorly, passing deep to the branches. The artery then split to give the buccal artery and the anterior deep temporal artery. In the pterygopalatine section, the maxillary artery branched off to form the common trunk of the infraorbital and sphenopalatine arteries and the posterior superior alveolar artery. It may be necessary to pay attention to the course of the maxillary artery and its relationship to the mandibular nerve branches, when a retroesophageal right subclavian artery is seen.
Subject(s)
Mandibular Nerve , Maxillary Artery , Subclavian Artery , Humans , Subclavian Artery/abnormalities , Female , Aged, 80 and over , Maxillary Artery/abnormalities , Cadaver , Esophagus/blood supply , Esophagus/abnormalities , Esophagus/innervationABSTRACT
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) can progress to fibrostenosis by unclear mechanisms. Herein, we investigated gene dysregulation in fibrostenotic EoE, its association with clinical parameters and specific pathways, and the functional consequences. METHODS: Esophageal biopsies from subjects with EoE were collected across 11 Consortium of Eosinophilic Gastrointestinal Disease Researchers sites (n = 311) and 2 independent replication cohorts (n = 83). Inclusion criteria for fibrostenotic EoE were endoscopic rings, stricture, and/or a history of dilation. Endoscopic, histologic, and molecular features were assessed by the EoE Endoscopic Reference Score, EoE Histology Scoring System, EoE Diagnostic Panel, and RNA sequencing. Esophageal endothelial TSPAN12 expression and functional effects on barrier integrity and gene expression were analyzed in vitro. RESULTS: TSPAN12 was the gene most correlated with fibrostenosis (r = -0.40, P < .001). TSPAN12 was lower in fibrostenotic EoE and correlated with EoE Endoscopic Reference Score, EoE Diagnostic Panel, and EoE Histology Scoring System (r = 0.34-0.47, P < .001). Lower TSPAN12 associated with smaller esophageal diameter (r = 0.44, P = .03), increased lamina propria fibrosis (r = -0.41, P < .001), and genes enriched in cell cycle-related pathways. Interleukin (IL)-13 reduced TSPAN12 expression in endothelial cells. Conversely, anti-IL-13 therapy increased TSPAN12 expression. TSPAN12 gene silencing increased endothelial cell permeability and dysregulated genes associated with extracellular matrix pathways. Endothelial cell-fibroblast crosstalk induced extracellular matrix changes relevant to esophageal remodeling. CONCLUSIONS: Patients with fibrostenotic EoE express decreased levels of endothelial TSPAN12. We propose that IL-13 decreases TSPAN12, likely contributing to the chronicity of EoE by promoting tissue remodeling through fibroblast-endothelial cell crosstalk.
Subject(s)
Endothelial Cells/metabolism , Eosinophilic Esophagitis/genetics , Esophageal Stenosis/genetics , Esophagus/blood supply , Fibroblasts/metabolism , Interleukin-13/metabolism , Tetraspanins/genetics , Adolescent , Adult , Child , Child, Preschool , Eosinophilic Esophagitis/complications , Eosinophilic Esophagitis/pathology , Esophageal Stenosis/etiology , Esophageal Stenosis/pathology , Female , Gene Expression Regulation , Gene Silencing , Humans , Male , Middle Aged , RNA, Small Interfering , Tetraspanins/metabolism , Young AdultABSTRACT
Decades of clinical, pathological, and epidemiological study and the recent application of advanced microarray and gene sequencing technologies have led to an understanding of the causes and pathogenesis of most recognized patterns of malformation. Still, there remain a number of patterns of malformation whose pathogenesis has not been established. Six such patterns of malformation are sirenomelia, VACTERL association, OEIS complex, limb-body wall defect (LBWD), urorectal septum malformation (URSM) sequence, and MURCS association, all of which predominantly affect caudal structures. On the basis of the overlap of the component malformations, the co-occurrence in individual fetuses, and the findings on fetal examination, a common pathogenesis is proposed for these patterns of malformation. The presence of a single artery in the umbilical cord provides a visible clue to the pathogenesis of all cases of sirenomelia and 30%-50% of cases of VACTERL association, OEIS complex, URSM sequence, and LBWD. The single artery is formed by a coalescence of arteries that supply the yolk sac, arises from the descending aorta high in the abdominal cavity, and redirects blood flow from the developing caudal structures of the embryo to the placenta. This phenomenon during embryogenesis is termed vitelline vascular steal.
Subject(s)
46, XX Disorders of Sex Development/diagnosis , Abnormalities, Multiple/diagnosis , Anal Canal/abnormalities , Congenital Abnormalities/diagnosis , Ectromelia/diagnosis , Esophagus/abnormalities , Heart Defects, Congenital/physiopathology , Kidney/abnormalities , Limb Deformities, Congenital/physiopathology , Mullerian Ducts/abnormalities , Spine/abnormalities , Trachea/abnormalities , 46, XX Disorders of Sex Development/physiopathology , Abnormalities, Multiple/physiopathology , Anal Canal/blood supply , Anal Canal/physiopathology , Anus, Imperforate/physiopathology , Aorta/pathology , Arteries/pathology , Congenital Abnormalities/physiopathology , Ectromelia/physiopathology , Embryo, Mammalian , Esophagus/blood supply , Esophagus/physiopathology , Extremities/blood supply , Extremities/embryology , Extremities/growth & development , Female , Fetus , Hernia, Umbilical/physiopathology , Humans , Kidney/blood supply , Kidney/physiopathology , Mullerian Ducts/blood supply , Mullerian Ducts/physiopathology , Pregnancy , Scoliosis/physiopathology , Spine/blood supply , Spine/physiopathology , Torso/blood supply , Torso/physiopathology , Trachea/blood supply , Trachea/physiopathology , Umbilical Cord/blood supply , Umbilical Cord/physiopathology , Urogenital Abnormalities/physiopathologySubject(s)
Esophageal Diseases/diagnosis , Esophageal Mucosa/blood supply , Esophageal Neoplasms/diagnosis , Esophagus/blood supply , Vascular Malformations/diagnosis , Diagnosis, Differential , Esophageal Mucosa/surgery , Esophagoscopy , Esophagus/surgery , Humans , Male , Medical Illustration , Middle AgedABSTRACT
When performing esophageal reconstruction, a colonic pedicle graft is chosen as the next candidate to the stomach because of complications arising from the operation time and vascular anastomosis. Vascular anastomosis is not necessarily required for pedicle grafts, but it is necessary to perform additional vascular anastomosis in some cases. We herein report a case of superdrainage in which anastomosis of the colonic vein and the right internal thoracic vein was effective against congestion. A 68-year-old man with thoracic esophageal cancer and pyloric antrum gastric cancer was referred to our hospital. Complete resection was performed with subtotal esophageal resection and total gastrectomy. We added superdrainage (right internal thoracic vein - ileocolic vein) to the colonic pedicle graft, which showed congestion, and performed esophageal reconstruction. Venous superdrainage using a colonic pedicle graft is effective for esophageal reconstruction.
Subject(s)
Anastomosis, Surgical/methods , Colon/surgery , Colon/transplantation , Esophageal Neoplasms/surgery , Esophagus/blood supply , Esophagus/surgery , Neoplasms, Multiple Primary/surgery , Plastic Surgery Procedures/methods , Veins/surgery , Aged , Colon/blood supply , Gastrectomy/methods , Humans , Male , Stomach Neoplasms/surgery , Treatment OutcomeABSTRACT
A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.
Subject(s)
Carcinoma, Hepatocellular/complications , Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/surgery , Liver Neoplasms/complications , Secondary Prevention/methods , Shock, Hemorrhagic/surgery , Adult , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/etiology , Esophagoscopy , Esophagus/blood supply , Esophagus/diagnostic imaging , Feasibility Studies , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Portal Vein/surgery , Recurrence , Secondary Prevention/instrumentation , Shock, Hemorrhagic/etiology , Stents , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.
Subject(s)
Alcohol Drinking/adverse effects , Esophageal Diseases/etiology , Esophagus/pathology , Gastrointestinal Hemorrhage/etiology , Hematemesis/etiology , Necrosis/diagnosis , Acute Disease , Adult , Aged , Aged, 80 and over , Awareness , Endoscopy/methods , Esophageal Diseases/pathology , Esophagus/abnormalities , Esophagus/blood supply , Female , Gastroesophageal Reflux/complications , Gastrointestinal Hemorrhage/therapy , Hematemesis/diagnosis , Humans , Male , Middle Aged , Proton Pump Inhibitors/therapeutic use , Resuscitation/methods , Treatment OutcomeABSTRACT
Esophagus and trachea arise from a common origin, the anterior foregut tube. The compartmentalization process of the foregut into the esophagus and trachea is still poorly understood. Esophageal atresia/tracheoesophageal fistula (EA/TEF) is one of the most common gastrointestinal congenital defects with an incidence rate of 1 in 2,500 births. EA/TEF is linked to the disruption of the compartmentalization process of the foregut tube. In EA/TEF patients, other organ anomalies and disorders have also been reported. Over the last two decades, animal models have shown the involvement of multiple signaling pathways and transcription factors in the development of the esophagus and trachea. Use of induced pluripotent stem cells (iPSCs) to understand organogenesis has been a valuable tool for mimicking gastrointestinal and respiratory organs. This review focuses on the signaling mechanisms involved in esophageal development and the use of iPSCs to model and understand it.
Subject(s)
Esophagus/embryology , Induced Pluripotent Stem Cells/cytology , Organogenesis , Trachea/embryology , Animals , Body Patterning , Esophagus/blood supply , Mice, Transgenic , Models, Animal , Signal TransductionABSTRACT
Exposure to acidic gastric content due to malfunction of lower esophageal sphincter leads to acute reflux esophagitis (RE) leading to disruption of esophageal epithelial cells. Carbon monoxide (CO) produced by heme oxygenase (HMOX) activity or released from its donor, tricarbonyldichlororuthenium (II) dimer (CORM-2) was reported to protect gastric mucosa against acid-dependent non-steroidal anti-inflammatory drug-induced damage. Thus, we aimed to investigate if CO affects RE-induced esophageal epithelium lesions development. RE induced in Wistar rats by the ligation of a junction between pylorus and forestomach were pretreated i.g. with vehicle CORM-2; RuCl3; zinc protoporphyrin IX, or hemin. CORM-2 was combined with NG-nitro-L-arginine (L-NNA), indomethacin, capsazepine, or capsaicin-induced sensory nerve ablation. Esophageal lesion score (ELS), esophageal blood flow (EBF), and mucus production were determined by planimetry, laser flowmetry, histology. Esophageal Nrf-2, HMOXs, COXs, NOSs, TNF-α and its receptor, IL-1 family and IL-1 receptor antagonist (RA), NF-κB, HIF-1α, annexin-A1, suppressor of cytokine signaling (SOCS3), TRPV1, c-Jun, c-Fos mRNA/protein expressions, PGE2, 8-hydroxy-deoxyguanozine (8-OHdG) and serum COHb, TGF-ß1, TGF-ß2, IL-1ß, and IL-6 content were assessed by PCR, immunoblotting, immunohistochemistry, gas chromatography, ELISA or Luminex platform. Hemin or CORM-2 alone or combined with L-NNA or indomethacin decreased ELS. Capsazepine or capsaicin-induced denervation reversed CORM-2 effects. COHb blood content, esophageal HMOX-1, Nrf-2, TRPV1 protein, annexin-A1, HIF-1α, IL-1 family, NF-κB, c-Jun, c-Fos, SOCS3 mRNA expressions, and 8-OHdG levels were elevated while PGE2 concentration was decreased after RE. CO donor-maintained elevated mucosal TRPV1 protein, HIF-1 α, annexin-A1, IL-1RA, SOCS3 mRNA expression, or TGF-ß serum content, decreasing 8-OHdG level, and particular inflammatory markers expression/concentration. CORM-2 and Nrf-2/HMOX-1/CO pathway prevent esophageal mucosa against RE-induced lesions, DNA oxidation, and inflammatory response involving HIF-1α, annexin-A1, SOCS3, IL-1RA, TGF-ß-modulated pathways. Esophagoprotective and hyperemic CO effects are in part mediated by afferent sensory neurons and TRPV1 receptors activity with questionable COX/PGE2 or NO/NOS systems involvement.
Subject(s)
Carbon Monoxide/pharmacology , Esophageal Mucosa/pathology , Esophagitis/pathology , Organometallic Compounds/pharmacology , Protective Agents/pharmacology , Acute Disease , Animals , Carboxyhemoglobin/metabolism , Cell Hypoxia/drug effects , Cyclooxygenase 2/genetics , Cyclooxygenase 2/metabolism , Cytokines/blood , Esophageal Mucosa/drug effects , Esophagitis/blood , Esophagus/blood supply , Esophagus/pathology , Heme Oxygenase-1/genetics , Heme Oxygenase-1/metabolism , Hypoxia-Inducible Factor 1, alpha Subunit/genetics , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Inflammation/pathology , Mucus/metabolism , NF-E2-Related Factor 2/genetics , NF-E2-Related Factor 2/metabolism , Nitric Oxide/metabolism , Oxidation-Reduction , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats, Wistar , Regional Blood Flow/drug effects , Sensory Receptor Cells/drug effects , Sensory Receptor Cells/metabolism , TRPV Cation Channels/metabolism , Up-Regulation/drug effectsABSTRACT
BACKGROUND: Distal contractile integral (DCI) is influenced by factors other than esophageal smooth muscle contractility, such as intrabolus pressure and vascular and respiratory movements' artifacts. We aimed to determine the size of the contribution of pressures generated by vascular compression on the esophagus to the DCI measured in HRM recordings in symptomatic patients. METHODS: HRM manometry recordings obtained from 383 subjects referred to the GI motility laboratory at a tertiary center (2012-2016) were evaluated by visual inspection for evidence of strong vascular compression (SVC) of the esophagus. Clinical, demographic, manometric, and serologic data for Chagas disease were obtained. Subjects were classified, respectively, as asymptomatics (ASYM) or symptomatics (SYMP). DCI and SVC-DCI were measured, and the SVC-DCI/DCI ratio was expressed as a percentage and the difference between DCI and SVC-DCI (neat-DCI) was calculated. DCI, SVC-DCI, SVC-DCI/DCI % and neat-DCI from SYMP and ASYM were compared. RESULTS: SVC was conspicuous in 42 of 383 subjects (11%). In 33 subjects, SVC was detected only in supine position. SVC was localized in middle esophagus in 21 subjects (50%), in distal esophagus in 12 subjects (29%) and in both regions in 9 subjects (21%). In 9 subjects, SVC vanished from the swallowing window analysis (21%). CONCLUSIONS: SVC is a common finding in esophageal HRM study, particularly in the supine position. Occasionally, its contribution to DCI value is sufficiently great to masquerade esophageal hypocontractility. Different manometric protocols may be required in patients with SVC.
Subject(s)
Chagas Disease/physiopathology , Esophageal Motility Disorders/physiopathology , Esophagus/blood supply , Manometry/methods , Muscle Contraction/physiology , Adult , Artifacts , Case-Control Studies , Chagas Disease/blood , Chagas Disease/diagnosis , Chagas Disease/epidemiology , Deglutition/physiology , Esophageal Motility Disorders/diagnosis , Esophagus/physiology , Female , Humans , Male , Middle Aged , Muscle, Smooth/physiology , Peristalsis/physiology , Pressure/adverse effects , PrevalenceABSTRACT
BACKGROUND AND AIM: Over the past years, three-dimensional (3D) models of patient-specific anatomical conditions are being used to improve the comprehension and surgical management of a variety of diseases. It is an additional diagnostic tool that aids clinical decision-making. Furthermore, this technology is still not routinely used in the medical field since its availability is limited by cost and complex process. METHODS AND RESULTS: We describe a patient with a balanced-type double aortic arch encircling trachea and esophagus. Considering the clinical symptoms, surgical decompression of these structures and defined aortic arch reconstruction was indicated. The 3D printed model revealed narrowing of the left aortic arch at the junction of the descending thoracic aorta that did not clearly appear on the conventional images reconstruction. The left aortic arch was divided and the symptoms completely disappeared. No immediate or late complications occurred. CONCLUSION: 3D printed models can be helpful in surgical planning of congenital heart malformations. It should be strongly considered as an additional tool in complex cases.
Subject(s)
Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Models, Anatomic , Patient Care Planning , Printing, Three-Dimensional , Decision Making , Decompression, Surgical/methods , Esophagus/blood supply , Humans , Infant , Male , Plastic Surgery Procedures/methods , Trachea/blood supply , Vascular Ring/surgery , Vascular Surgical Procedures/methodsABSTRACT
BACKGROUND: After an esophageal resection, continuity is commonly restored by a gastric tube reconstruction and an intrathoracic anastomosis to the remaining proximal esophagus. Ischemia of the anastomotic region is considered to play a pivotal role in anastomotic leakage. Microdialysis (µD) is an excellent method to measure local biochemical substances and parameters in a specific organ or compartment aiming at early detection of ischemia. This animal study evaluates ischemia of the gastric tube reconstruction using a novel method-µD on organ surfaces. This promising method may have the potential to detect an anastomotic leakage before clinical symptoms develop. METHODS: Anesthetized normoventilated pigs were used. Surface microdialysis (S-µD) catheters and an intraparenchymal oxygen tension catheter were placed on the stomach. A gastric tube was made and the gastroepiploic artery was divided halfway along the greater curvature to produce severe ischemia at the top of the gastric tube. µD data from four locations (gastric tube, ileum and peritoneal cavity) were recorded every 20 min during the experiment. Tissue samples from all catheter sites underwent histopathological analysis. Intraparenchymal oxygen partial pressure, systemic blood tests, and hemodynamic parameters were recorded. RESULTS: S-µD data showed values indicating severe ischemia at the top of the gastric tube and intermediate ischemia at the level of transection of the gastroepiploic artery. Ischemia was verified by histopathological analysis of tissue samples and intraparenchymal oxygen tension data. CONCLUSIONS: S-µD can detect and grade severity of local ischemia in real time, in an animal model.
Subject(s)
Anastomotic Leak/diagnosis , Esophagectomy/adverse effects , Esophagus/blood supply , Ischemia/diagnosis , Microdialysis/methods , Anastomosis, Surgical/adverse effects , Animals , Disease Models, Animal , Esophagus/pathology , Esophagus/surgery , Humans , Ischemia/etiology , Ischemia/pathology , Oxygen/analysis , Severity of Illness Index , Sus scrofaABSTRACT
Left-sided portal hypertension is a very uncommon condition and retroperitoneal fibrosis has rarely been reported as a cause. We present the case of a 77-year-old man with retroperitoneal fibrosis obstructing the splenic vein and causing recurrent episodes of upper gastrointestinal bleeding. Computed tomography showed a retroperitoneal mass as being responsible for the obstruction of the splenic vein, splenomegaly, and diffuse varices around the gastrosplenic and gastrohepatic ligaments. An oesophagus preserving, modified Sugiura procedure was performed with disconnection of the gastric vessels on the lesser curve of the stomach, preserving the pylorus branches of the nerves of Latarjet.
Subject(s)
Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/surgery , Organ Sparing Treatments , Retroperitoneal Fibrosis/complications , Vascular Surgical Procedures , Aged , Esophageal and Gastric Varices/etiology , Esophagus/blood supply , Gastrointestinal Hemorrhage/etiology , Humans , Male , Retroperitoneal Fibrosis/diagnosis , Retroperitoneal Space/diagnostic imaging , Splenectomy , Stomach/blood supply , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVES: Guidelines for magnified endoscopic diagnosis of esophageal squamous cell carcinoma (SCC) have been proposed by the Japan Esophageal Society. Type B1, B2, and B3 reflect increasing tumor invasion depths (within mucosal epithelium or into lamina propria mucosa [T1a-EP/LPM], into muscularis mucosa or superficial invasion into submucosa [T1a-MM/T1b-SM1], and into submucosa [T1b-SM2], respectively). The diagnostic accuracy of type B1 and B3 is high, but accuracy of type B2 is low. We aimed to improve the diagnostic accuracy of type B2. METHODS: We retrospectively reviewed 248 SCC lesions treated with endoscopic submucosal dissection between January 2012 and July 2018 and identified the B2 lesions. The maximum diameter of the area presenting B2 was measured and evaluated in relation to tumor invasion, for which receiver-operating characteristic (ROC) curves were generated. The optimal area size for distinguishing T1a-EP/LPM from T1a-MM or deeper invasion was determined. RESULTS: There were 78 lesions with B2, of which 26 (33%) were T1a-MM or T1b-SM1 SCCs. ROC curve analysis indicated that the optimal cut-off for the target area showing B2 was 4 mm. The invasion depth (EP/LPM: MM/SM1: SM2) of B2 observed in an area with a diameter <4 mm (B2-Narrow) and those with diameter ≥4 mm (B2-Broad) was 46:11:1 and 1:15:4, respectively. To predict T1a-MM or deeper invasion, B2-Broad had a sensitivity, specificity, positive predictive value, and negative predictive value of 61%, 98%, 95%, and 79%, respectively. CONCLUSION: The diagnostic accuracy of type B2 was improved by evaluating the area of type B2.
Subject(s)
Esophageal Neoplasms/pathology , Esophageal Squamous Cell Carcinoma/pathology , Esophagoscopy/methods , Esophagus/pathology , Microvessels/pathology , Neoplasm Invasiveness/pathology , Aged , Aged, 80 and over , Endoscopic Mucosal Resection , Esophageal Mucosa/blood supply , Esophageal Mucosa/pathology , Esophageal Neoplasms/classification , Esophageal Neoplasms/surgery , Esophageal Squamous Cell Carcinoma/classification , Esophageal Squamous Cell Carcinoma/surgery , Esophagus/blood supply , Female , Humans , Male , Middle Aged , Narrow Band Imaging , Retrospective StudiesABSTRACT
Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as "black esophagus." Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether "black esophagus" is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, Pâ<â.05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (Pâ<â.05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, Pâ<â.05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.
Subject(s)
Esophageal Diseases/mortality , Gastrointestinal Hemorrhage/mortality , Necrosis/diagnostic imaging , Necrosis/mortality , Acute Disease , Aged , Albumins/analysis , Duodenal Ulcer/epidemiology , Endoscopy, Digestive System/methods , Esophageal Diseases/diagnostic imaging , Esophageal Diseases/pathology , Esophagus/blood supply , Esophagus/pathology , Female , Gastrointestinal Hemorrhage/etiology , Hemoglobins/analysis , Humans , Male , Middle Aged , Necrosis/complications , Necrosis/pathology , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Sepsis/epidemiology , Sepsis/etiology , Sepsis/mortalityABSTRACT
Objective: To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods: The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results: There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow-up on one week post operation. Three patients were treated with the endo-therapy at the twice follow-up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion: The ESVD for EGVB is safe and effective, but the long-term curative effect should be further studied.
Subject(s)
Digestive System Surgical Procedures/methods , Esophagus/surgery , Gastrointestinal Hemorrhage/surgery , Veins/surgery , Child , Child, Preschool , Endoscopy , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnostic imaging , Esophageal and Gastric Varices/surgery , Esophagus/blood supply , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Humans , Male , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Biomedical imaging devices that utilize the optical characteristics of hemoglobin (Hb) have become widespread. In the field of gastroenterology, there is a strong demand for devices that can apply this technique to surgical navigation. We aimed to introduce our novel multispectral device capable of intraoperatively performing quantitative imaging of the oxygen (O2) saturation and Hb amount of tissues noninvasively and in real time, and to examine its application for deciding the appropriate anastomosis point after subtotal or total esophagectomy. MATERIALS AND METHODS: A total of 39 patients with esophageal cancer were studied. Tissue O2 saturation and Hb amount of the gastric tube just before esophagogastric anastomosis were evaluated using a multispectral tissue quantitative imaging device. The anastomosis point was decided depending on the quantitative values and patterns of both the tissue O2 saturation and Hb amount. RESULTS: The device can instantaneously and noninvasively quantify and visualize the tissue O2 saturation and Hb amount using reflected light. The tissue Hb status could be classified into the following four types: good circulation type, congestion type, ischemia type, and mixed type of congestion and ischemia. Postoperative anastomotic failure occurred in 2 cases, and both were mixed cases. CONCLUSIONS: The method of quantitatively imaging the tissue O2 saturation and Hb level in real time and noninvasively using a multispectral device allows instantaneous determination of the anastomosis and related organ conditions, thereby contributing to determining the appropriate treatment direction.