Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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The invasion depth of superficial esophageal squamous cell carcinoma is important in determining therapeutic strategy. The aim of this study was to prospectively investigate the clinical utility of magnifying endoscopy with narrow band imaging compared with that of non-magnifying high-resolution endoscopy or high-frequency endoscopic ultrasonography in predicting the depth of superficial esophageal squamous cell carcinoma. The techniques were carried out in 72 patients with 101 superficial esophageal squamous cell carcinomas, which were then resected by either endoscopic mucosal resection or esophagectomy. ⋯ There were no statistically significant differences among the three endoscopic techniques. Clinical utility of magnifying endoscopy with narrow band imaging does not seem to be significantly different from that of non-magnifying high-resolution endoscopy or high-frequency endoscopic ultrasonography in predicting the depth of superficial esophageal squamous cell carcinoma. Magnifying endoscopy with narrow band imaging may have potential to reduce overestimation risks of non-magnifying high-resolution endoscopy or high-frequency endoscopic ultrasonography.
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Comparative Study
Angleplasty in gastric tube reconstruction after esophagectomy.
Anastomotic leakage after radical esophagectomy is mostly caused by the hypoxia and high tension at the esophagogastric anastomotic site. Here, we introduce a new surgical technique, 'Angleplasty,' to enable the tensionless anastomosis at a highly oxygenic site of gastric conduit. ⋯ With this maneuver, the lesser curvature of the gastric roll is significantly elongated and the anastomosis site of the gastric conduit can be moved more distal on the greater curvature of the stomach where it is expected to receive more oxygen supply. This technique takes only several minutes, but provides highly favorable conditions for esophagogastric anastomosis and thus is clinically useful to reduce the risk of anastomotic leakage after esophagectomy.
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Greater than 50% of patients with esophageal carcinoma are found to be incurable at the time of diagnosis, leaving only palliative options. Self-expanding metal stents (SEMs) are effective for relieving symptoms and complications associated with esophageal carcinoma and improving quality of life. We undertook a retrospective analysis to evaluate the experience of palliative esophageal stenting for symptomatic malignant dysphagia in our institution over a period of 7 years. ⋯ There is no significant difference in complications or survival when using endoscopic or radiologic methods to deploy SEMs in patients with inoperable esophageal cancer. Mortality is low; however, the morbidity rate is significant. Patients receiving adjuvant chemotherapy or radiotherapy, in addition to stenting, survived significantly longer than those with a stent only.
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Identification of aberrant promoter methylation of EDNRB gene in esophageal squamous cell carcinoma.
Epigenetic silencing of tumor suppressor genes is a major contributor to neoplastic transformation and is an area of intense research. The purpose of the present study was to identify the epigenetic changes in esophageal squamous cell carcinoma (ESCC). Methylation-sensitive arbitrarily primed polymerase chain reaction analysis was used on 21 matched ESCC tumors and adjacent normal tissues. ⋯ Real-time PCR analysis demonstrated that EDNRB mRNA expression was significantly reduced in tumors showing high promoter methylation compared with paired normal tissues, whereas there is no significant difference between other paired samples. In addition, treatment of ESCC cell line with 5-aza-2'-deoxycytidine led to reexpression of the EDNRB transcript, which is correlated with the reversal of the methylation status of EDNRB promoter. In conclusion, promoter hypermethylation of EDNRB gene, which is associated with the loss of EDNRB mRNA expression, may play a role in the development of ESCC.
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Comparative Study
Effects of neoadjuvant chemotherapy on primary tumor and lymph node metastasis in esophageal squamous cell carcinoma: additive association with prognosis.
Neoadjuvant chemotherapy (NACT) is widely used to treat esophageal squamous cell carcinoma with lymph node metastasis (ESCC). However, NACT frequently has differential effects on primary tumor (PT) and lymph node metastasis (LNM). The clinical significance of this phenomenon remains unclear. ⋯ Multivariate analysis identified neither the PT nor the LNM response alone as an independent prognostic factor; however the combined PT/LNM response was identified as an independent prognostic factor (hazard ratio [HR] 2.861, P = 0.0255) in addition to the number of histological lymph node metastases (HR 2.551, P = 0.0328). The response to NACT in LNM and PT correlates closely with postoperative survival. A good response in both enhances the postoperative prognosis.