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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 25673

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Special Issue Editor

Dr. Toshiro Iizuka

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Guest Editor

Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
Interests: esophageal disease; esophageal cancer; endoscopic submucosal dissection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advances in equipment of endoscopy as well as skillful endoscopic techniques have enabled the treatment of benign and malignant esophageal disease that require multidisciplinary treatment approaches. In terms of superficial esophageal cancer, including adenocarcinoma, the standard treatment still remains disputable. Needless to say, endoscopic submucosal dissection (ESD) has been accepted widely; however, it is nothing more than a possibility. For patients with potential lymph node metastasis, comprehensive tactics such as combination treatments and multimodality approaches are being utilized with increasing frequency. However, the indications for and outcomes of multimodality therapy for these cancers require additional research. Regarding benign esophageal disease such as achalasia, GERD, or diverticulum, some endoscopic therapies are expected to have a great impact on clinical practice and are rapidly or gradually pervasive. However, some long-term outcomes still require further investigation. The aim of this Special Issue is to highlight advances in the recent cutting-edge treatment and short- or long-term outcome of those treatments.

Dr. Toshiro Iizuka
Guest Editor

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Keywords

Esophageal disease
Superficial Barrett adenocarcinoma
Superficial esophageal squamous cell carcinoma
Achalasia
GERD
Esophageal diverticulum
Treatments
Endoscopic submucosal dissection
POEM
Proton pump inhibitor

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Published Papers (7 papers)

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Research

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8 pages, 604 KiB

Open AccessArticle

Peroral Endoscopic Myotomy in the Management of Zenker’s Diverticulum: A Retrospective Multicenter Study

by Aleksandra Budnicka, Władysław Januszewicz, Andrzej B. Białek, Michal Spychalski, Jaroslaw Reguła and Michal F. Kaminski

J. Clin. Med. 2021, 10(2), 187; https://doi.org/10.3390/jcm10020187 - 7 Jan 2021

Cited by 22 | Viewed by 2324

Abstract

Background: Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker’s diverticulum (ZD). This study aimed to analyze the feasibility of Zenker’s POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD. Materials and methods: This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2–3 months follow-up). Secondary outcome measures included procedures’ duration, length of hospital stay, and adverse events. Results: 22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24–40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2–3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation. Conclusions: This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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20 pages, 2111 KiB

Open AccessArticle

Comparative Analysis of Blood and Bone Marrow for the Detection of Circulating and Disseminated Tumor Cells and Their Prognostic and Predictive Value in Esophageal Cancer Patients

by Florian Richter, Annette Baratay, Christian Röder, Jan-Hendrik Egberts, Holger Kalthoff, Thomas Becker and Susanne Sebens

J. Clin. Med. 2020, 9(8), 2674; https://doi.org/10.3390/jcm9082674 - 18 Aug 2020

Cited by 4 | Viewed by 2447

Abstract

Hematogenic tumor cell spread is a key event in metastasis. However, the clinical significance of circulating tumor cells (CTC) in the blood and disseminated tumor cells (DTC) in bone marrow is still not fully understood. Here, the presence of DTC and CTC in esophageal cancer (EC) patients and its correlation with clinical parameters was investigated to evaluate the CTC/DTC prognostic value in EC. This study included 77 EC patients with complete surgical tumor resection. CTC and DTC were analyzed in blood and bone marrow using nested CK20 reverse transcription-nested polymerase chain reaction (RT-PCR) and findings were correlated with clinical data. Twenty-seven of 76 patients (36.5%) showed CK20 positivity in the blood, 19 of 61 patients (31.1%) in bone marrow, and 40 (51.9%) of 77 patients were positive in either blood or bone marrow or both. In multivariate analyses, only the DTC status emerged as independent predictor of overall and tumor specific survival. Our study revealed that, while the presence of CTC in blood is not associated with a worse prognosis, DTC detection in the bone marrow is a highly specific and independent prognostic marker in EC patients. Larger cohort studies could unravel how this finding can be translated into improved therapy management in EC. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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14 pages, 1057 KiB

Open AccessArticle

Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients

by Elise Piraux, Gilles Caty, Gregory Reychler, Patrice Forget and Yannick Deswysen

J. Clin. Med. 2020, 9(7), 2176; https://doi.org/10.3390/jcm9072176 - 9 Jul 2020

Cited by 37 | Viewed by 3453

Abstract

Tele-rehabilitation provides better access to healthcare services and optimizes exercise adherence. However, its feasibility and effectiveness are unknown in the preoperative period in esophagogastric cancer patients. We aimed to assess the feasibility and the preliminary effects of a “tele-prehabilitation” program in esophagogastric cancer patients requiring surgery. Enrolled participants performed an internet-based tele-prehabilitation including aerobic, resistance and inspiratory muscle training over 2–4 weeks. The primary outcome was feasibility, measured in terms of recruitment, retention and attendance rates, adverse events and patient satisfaction. Secondary outcomes (functional exercise capacity, fatigue, quality of life, anxiety and depression) were assessed at baseline, presurgery, and 4 and 12 weeks postsurgery. Among the 24 eligible subjects, 23 were enrolled, 22 performed the intervention and 15 completed the study. Recruitment and retention rates were both 96%. Attendances to aerobic and resistance sessions and inspiratory muscle training were 77% and 68%, respectively. No adverse events occurred, and the satisfaction was excellent. After prehabilitation, participants significantly improved fatigue (p = 0.039), quality of life (p = 0.009), physical well-being (p = 0.034), emotional well-being (p = 0.005) and anxiety (p = 0.044). This study demonstrated the feasibility of a tele-prehabilitation in esophagogastric cancer patients undergoing surgery, with a high recruitment rate, retention rate and satisfaction, a good attendance to exercise sessions and no exercise-related adverse events. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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13 pages, 355 KiB

Open AccessArticle

Positive Fecal Immunochemical Test Results Are Associated with Increased Risks of Esophageal, Stomach, and Small Intestine Cancers

by Yoon Suk Jung, Jinhee Lee and Chang Mo Moon

J. Clin. Med. 2020, 9(7), 2172; https://doi.org/10.3390/jcm9072172 - 9 Jul 2020

Cited by 7 | Viewed by 2847

Abstract

Background: The current guideline does not recommend upper gastrointestinal evaluation for patients with a positive fecal immunochemical test (FIT) and negative colonoscopy results. However, this indication was based on low-quality evidence as data on this issue are very limited. We assessed the risk of proximal cancers (oral or throat, esophageal, stomach, and small intestine cancers) after negative or positive FIT results in the Korean National Cancer Screening Program (NCSP). Methods: Using the NCSP databases, we collected data on participants who underwent FIT between 2009 and 2011. Participants were classified based on FIT results and colorectal cancer (CRC) diagnosed within 1 year after FIT as FIT− (n = 5,551,755), FIT+/CRC− (n = 368,553), and FIT+/CRC+ (n = 12,236). Results: The incidence rates of overall proximal cancers in FIT−, FIT+/CRC−, and FIT+/CRC+ patients within 1, 2, and 3 years after FIT were 0.38%, 0.68%, and 2.26%; 0.57%, 0.93%, and 2.74%; and 0.79%, 1.21%, and 3.15%, respectively. After adjusting confounding variables, the risks of esophageal, stomach, and small intestine cancers as well as overall proximal cancers within 1, 2, and 3 years after FIT were higher in FIT+/CRC− patients than those in FIT− patients. However, the risk of oral or throat cancer did not differ between FIT− and FIT+/CRC− patients. The risks for oral or throat cancer and small intestine cancer were higher in FIT+/CRC+ patients than those in FIT+/CRC− patients. Conclusions: In this population-based study, FIT+/CRC− patients were at higher risk for esophageal, stomach, and small intestine cancers than were FIT− patients, suggesting that positive FIT results were associated with these cancers. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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11 pages, 930 KiB

Open AccessArticle

Photodynamic Therapy Using Talaporfin Sodium for Local Failure after Chemoradiotherapy or Radiotherapy for Esophageal Cancer: A Single Center Experience

by Natsuki Ishida, Satoshi Osawa, Takahiro Miyazu, Masanao Kaneko, Satoshi Tamura, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Takahisa Furuta and Ken Sugimoto

J. Clin. Med. 2020, 9(5), 1509; https://doi.org/10.3390/jcm9051509 - 17 May 2020

Cited by 16 | Viewed by 2756

Abstract

A phase II study of second-generation photodynamic therapy (PDT) using talaporfin sodium has shown excellent treatment results for esophageal cancer with local failure after chemoradiotherapy (CRT) or radiotherapy (RT). However, only a few studies have reported this therapy in clinical practice. This study aimed to confirm the efficacy and safety of salvage PDT using talaporfin sodium for esophageal cancer in various clinical situations. Twelve patients with esophageal cancer with local failure after definitive CRT or RT who underwent PDT using talaporfin sodium were enrolled from April 2016 to January 2020. Overall, 10 patients (83.3%) achieved a local complete response. No skin phototoxicity was observed, but esophageal stricture occurred in five patients (41.7%). Esophageal stricture was improved with endoscopic balloon dilation in all patients, and subsequent analysis found no significant factors causing esophageal stricture after PDT. Two patients with synchronous tumors were successfully rescued by combination therapy with endoscopic submucosal dissection. Two patients with carcinoma in situ of larger than 1/2 circumference were rescued by repeated PDT. The 2-year overall survival was 80.0% (95% confidence interval 0.409–0.946). PDT using talaporfin sodium was an effective and safe salvage treatment for esophageal cancer with local failure after CRT or RT in various clinical situations. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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Review

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9 pages, 1039 KiB

Open AccessReview

Preoperative Diagnosis and Indications for Endoscopic Resection of Superficial Esophageal Squamous Cell Carcinoma

by Katsunori Matsueda and Ryu Ishihara

J. Clin. Med. 2021, 10(1), 13; https://doi.org/10.3390/jcm10010013 - 23 Dec 2020

Cited by 10 | Viewed by 2216

Abstract

Endoscopic resection (ER) is the mainstay of treatment for superficial esophageal squamous cell carcinoma (SESCC) instead of esophagectomy because of its minimal invasiveness and favorable clinical outcomes. Developments in endoscopic submucosal dissection have enabled en bloc resection of SESCCs regardless of size, thus reducing the risk of local recurrence. Although ER for SESCC is effective, metastasis may subsequently occur. Additionally, extensive esophageal ER confers a risk of postoperative esophageal stricture. Therefore, accurate assessment of the invasion depth and circumferential extent of SESCCs is important in determining the indications for ER. Diagnostic accuracies for SESCC invasion differ between epithelial (EP)/lamina propria (LPM), muscularis mucosa (MM)/submucosal (SM1), and SM2 cancers. ER is strongly indicated for clinically diagnosed (c)EP/LPM cancers because 90% of these are as pathologically diagnosed (p)EP/LPM, which has a very low risk of metastasis. Remarkably, the diagnostic accuracy for cMM/SM1 differs significantly with lateral spread of cancer. Eighty percent of cMM/SM1 cancers with ≤3/4 circumferential spread prove to be pEP/LPM or pMM/SM1, which have very low or low risk of metastasis. Thus, these are adequate candidates for ER. However, given the relatively low proportion of pEP/LPM or pMM/SM1 and high risk of subsequent stricture, ER is not recommended for whole circumferential cMM/SM1 cancers. For cMM/SM1 cancers that involve >3/4 but not the whole circumference, ER should be considered on a lesion-by-lesion basis because the risk of post-ER stricture is not very high, but the proportion of pEP/LPM or pMM/SM1 is relatively low. ER is contraindicated for cSM2 cancers because 75% of them are pSM2, which has high risk of metastasis. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

Other

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13 pages, 1954 KiB

Open AccessSystematic Review

Efficacy and Safety of Domperidone in Combination with Proton Pump Inhibitors in Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

by Nur Fathurah Zamani, Afifah Sjamun Sjahid, Tuan Hairulnizam Tuan Kamauzaman, Yeong Yeh Lee and Md Asiful Islam

J. Clin. Med. 2022, 11(18), 5268; https://doi.org/10.3390/jcm11185268 - 7 Sep 2022

Cited by 10 | Viewed by 8648

Abstract

The aims of gastroesophageal reflux disease (GERD) treatment are symptom relief and healing of oesophagitis. Besides proton pump inhibitors (PPIs), prokinetic agents are also commonly prescribed to treat GERD. Domperidone, a well-known antiemetic, is an example of a prokinetic agent. It is a dopaminergic blocker that increases lower oesophagus sphincter pressure and activates gastric motility. We carried out a systematic review and meta-analysis to explore the benefits of domperidone in addition to PPI therapy for GERD. We searched for publications comparing PPI plus domperidone to PPI monotherapy in terms of symptom improvement in GERD (until 21 April 2022) on PubMed, Scopus, Google Scholar, Web of Science, Cochrane Library, WHO’s International Clinical Studies Registry Platform, and ClinicalTrials.gov without restricting date, language, or study design. The protocol was registered in PROSPERO (CRD42021242076). This meta-analysis incorporated 11 studies with a total of 841 participants (419 in the PPI plus domperidone group and 422 in the PPI monotherapy group). The combination of a PPI and domperidone resulted in a significant reduction in global GERD symptoms. Adverse events associated with PPI plus domperidone treatment were similar to those associated with PPI monotherapy. In conclusion, the combination of domperidone and a PPI is generally safe and effective in treating GERD as compared with that of PPI alone. Full article

(This article belongs to the Special Issue New Treatments for Esophageal Diseases)

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