Post-oesophagectomy anastomotic-bronchial fistula

Anastomotic leakage after oesophagectomy is a dreaded complication. It has a wide range of presentations ranging from the patient being totally asymptomatic to septic with multiorgan failure. From the literature, in general, cervical anastomoses have a higher leakage rate than those that are intra-thoracic, but leaks from the latter confer greater morbidity. Cervical anastomotic leaks that are truly confined to the neck can be managed conservatively, but can extend into the mediastinum and result in more serious complications. Herein, we report on a patient with an oesophago-gastric anastomosis constructed in the neck but with extension into the mediastinum. Subsequently, the patient developed a fistulous erosion into the tracheobronchial tree, which was successfully managed endoscopically.published_or_final_versio

Management of oesophageal cancer

Oesophageal cancer is a disease of dismal prognosis. There are variations of epidemiology among different ethnic groups and geographic regions. India is a country with high incidence. This can be attributed to the interplay between environmental, dietary factors and life-style of the population of the country. Optimal therapeutic strategy for patients with oesophageal cancer demands individual consideration. Majority of oesophageal cancer patients present at an advanced stage of disease. Screening programmes or strategies aiming at early diagnosis can improve the prognosis; unfortunately this is not cost-effective except in very high incidence areas. Accurate staging can help select the most appropriate treatments, such as excluding those patients with metastatic disease who are unlikely to benefit from surgery, and treating very early lesions with endoscopic means. When surgery is indicated, treating patient in a high-volume centre can improve the outcome and minimise complications. Although surgical resection remains the main treatment modality, long-term prognosis after surgical resection alone has been suboptimal except in those with early disease. Multidisciplinary approaches including chemotherapy and radiotherapy with or without surgery are increasingly employed for patients with advanced disease. Collaboration among surgeons, clinical oncologists, radiologists and physicians is of utmost importance to achieve the best results. Treatment for patients should be individualised to enhance outcome. © Association of Surgeons of India 2009.published_or_final_versio

Hong Kong dollar in the Oesophagus

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Standardized uptake value (SUV) in PET/CT for esophageal cancer correlates with pathological stage and predicts R-category of resection

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Comparison of effects of sleeve gastrectomy, duodenal-jejunal bypass and ileal transposition for type II diabetes

Oral Presentations: OS9 - Surgery for Diabetes: no. OS9.02INTRODUCTION: Sleeve gastrectomy (SG), duodenal jejuna bypass (DJB) and ileal transposition (IT) have been reported to be effective for the treatment of T2DM. OBJECTIVES: It is unknown which procedure has a stronger anti-diabetic effect. The purpose of this study was to compare the effectiveness of these novel procedures METHODS: SG, DJB, IT and sham operation of each procedure were performed in 10-12 weeks old Goto-Kakizaki rats, a spontaneous non-obese model of T2DM. The glucose homeostasis effect was evaluated by measuring fasting glucose (FBG) and glycosylated haemoglobin (HbA1c). Gut hormonal profiles and lipid absorption were also examined. Rats were observed for 1 year. RESULTS: All three procedures had significant lower FBG when compared to the respective sham groups. DJB and IT had lower FBG than SG (SG vs DJB, p=0.023; SG vs IT, p=0.009) whereas DJB and IT had a similar FBG level, p=0.678. For HbA1c, all procedures had lower levels than the respective sham groups, p<0.001. The HbA1c of SG rebounded on 8th week whereas HbA1c of DJB and IT remained at low level. SG had a significant higher HbA1c level than DJB and IT, p<0.001 while DJB and IT had a similar level, p=0.685. GLP-1 and PYY were raised in DJB and IT whereas GIP level increased in DJB. All three procedures have different lipid absorption profile. CONCLUSION: SG, DJB and IT all had anti-diabetic effect. DJB and IT had more potent anti-diabetic effect than SG. Each procedure has different effects on metabolic diseases and their clinic application deserve individual consideration.published_or_final_versio

Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: magnifying endoscopy findings

Gastric mucosaâ associated lymphoid tissue lymphoma is uncommon and most patients have an indolent clinical course. The clinical presentation and endoscopic findings can be subtle and diagnosis can be missed on white light endoscopy. Magnifying endoscopy may help identify the abnormal microstructural and microvascular patterns, and target biopsies can be performed. We describe herein the case of a 64-year-old woman with Helicobacter pyloriâ negative gastric mucosaâ associated lymphoid tissue lymphoma diagnosed by screening magnification endoscopy. Helicobacter pyloriâ eradication therapy was given and she received biological therapy. She is in clinical remission after treatment. The use of magnification endoscopy in gastric mucosaâ associated lymphoid tissue lymphoma and its management are reviewed.published_or_final_versio

Comparison of effects of sleeve gastrectomy, duodenal-jejunal bypass and ileal transposition for the treatment of type II diabetes

This journal suppl. entitled: 2014 DDW AbstractThe SSAT’s 55th Annual Meeting took place during Digestive Disease Week 2014SSAT Poster Session (8215) - Stomach: Basic (I)BACKGROUND: Sleeve gastrectomy (SG), duodenal jejunal bypass (DJB) and ileal transposition (IT) have been reported to be effective for the treatment of T2DM. It is unknown which procedure has a stronger anti-diabetic effect. The purpose of this study was to compare the effectiveness of these novel procedures METHODS: SG, DJB, IT and ...postprin

Histological regression of squamous esophageal carcinoma assessed by percentage of residual viable cells after neoadjuvant chemoradiation is an important prognostic factor

Background: Whether the TNM staging system is applicable after neoadjuvant chemoradiation in esophageal cancer is controversial. The aim of this study was to evaluate the prognostic value of histopathological regression of the primary tumor in postchemoradiated patients. Materials and Methods: The pretherapeutic and pathological ypTNM stages of patients who have had neoadjuvant chemoradiation followed by esophagectomy were analyzed. The percentage of residual viable cells of the primary tumor (ypV) and other clinicopathological factors were tested for their prognostic value. Results: Of 175 recruited patients, 55 (31.4%) achieved pathological complete response. The median survival of these 55 patients was significantly longer than those with other disease stages (124.8 vs 21.1 months) (P <.001). Gender, ypT, ypN, ypTNM, and ypV stage were significant prognostic factors in univariate analysis. In patients without nodal metastases, the median survival in patients with residual viable cells in the primary tumor (ypV?) was 24.6 months, compared with that of 124.8 months in those with no viable cells (ypV0) (P =.043). In those who had nodal metastases, the median survival of patients with ypV0 and ypV? were 21.2 months and 17.4 months respectively (P =.37). Cox regression analysis showed that male gender, high percentage of residual viable cells (ypV), and positive nodal status (ypN1) were independent predictors of poor prognosis. Conclusions: In patients who underwent neoadjuvant chemoradiation therapy, histopathological regression of the primary tumor indicated by percentage of residual viable cells is an important prognostic factor in addition to nodal status and gender. © The Author(s) 2010.published_or_final_versionSpringer Open Choice, 01 Dec 201

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

Introduction: The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment. Methods: We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed. Results: We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaaveâ s syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, < 0.01, and < 0.01, respectively). Conclusions: Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.published_or_final_versio

A Versatile Orthotopic Nude Mouse Model for Study of Esophageal Squamous Cell Carcinoma

Increasing evidence indicates tumor-stromal interactions play a crucial role in cancer. An in vivo esophageal squamous cell carcinoma (ESCC) orthotopic animal model was developed with bioluminescence imaging established with a real-time monitoring platform for functional and signaling investigation of tumor-stromal interactions. The model was produced by injection of luciferase-labelled ESCC cells into the intraesophageal wall of nude mice. Histological examination indicates this orthotopic model is highly reproducible with 100% tumorigenesis among the four ESCC cell lines tested. This new model recapitulates many clinical and pathological properties of human ESCC, including esophageal luminal stricture by squamous cell carcinoma with nodular tumor growth, adventitia invasion, lymphovascular invasion, and perineural infiltration. It was tested using an AKT shRNA knockdown of ESCC cell lines and the in vivo tumor suppressive effects of AKT knockdown were observed. In conclusion, this ESCC orthotopic mouse model allows investigation of gene functions of cancer cells in a more natural tumor microenvironment and has advantages over previous established models. It provides a versatile platform with potential application for metastasis and therapeutic regimen testing.published_or_final_versio