Articles de revues : « Esophageal substitue »

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Marzaro, Maurizio, Mattia Algeri, Luigi Tomao, Stefano Tedesco, Tamara Caldaro, Valerio Balassone, Anna Chiara Contini et al. « Successful muscle regeneration by a homologous microperforated scaffold seeded with autologous mesenchymal stromal cells in a porcine esophageal substitution model ». Therapeutic Advances in Gastroenterology 13 (janvier 2020) : 175628482092322. http://dx.doi.org/10.1177/1756284820923220.

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Background: Since the esophagus has no redundancy, congenital and acquired esophageal diseases often require esophageal substitution, with complicated surgery and intestinal or gastric transposition. Peri-and-post-operative complications are frequent, with major problems related to the food transit and reflux. During the last years tissue engineering products became an interesting therapeutic alternative for esophageal replacement, since they could mimic the organ structure and potentially help to restore the native functions and physiology. The use of acellular matrices pre-seeded with cells showed promising results for esophageal replacement approaches, but cell homing and adhesion to the scaffold remain an important issue and were investigated. Methods: A porcine esophageal substitute constituted of a decellularized scaffold seeded with autologous bone marrow-derived mesenchymal stromal cells (BM-MSCs) was developed. In order to improve cell seeding and distribution throughout the scaffolds, they were micro-perforated by Quantum Molecular Resonance (QMR) technology (Telea Electronic Engineering). Results: The treatment created a microporous network and cells were able to colonize both outer and inner layers of the scaffolds. Non seeded (NSS) and BM-MSCs seeded scaffolds (SS) were implanted on the thoracic esophagus of 4 and 8 pigs respectively, substituting only the muscle layer in a mucosal sparing technique. After 3 months from surgery, we observed an esophageal substenosis in 2/4 NSS pigs and in 6/8 SS pigs and a non-practicable stricture in 1/4 NSS pigs and 2/8 SS pigs. All the animals exhibited a normal weight increase, except one case in the SS group. Actin and desmin staining of the post-implant scaffolds evidenced the regeneration of a muscular layer from one anastomosis to another in the SS group but not in the NSS one. Conclusions: A muscle esophageal substitute starting from a porcine scaffold was developed and it was fully repopulated by BM-MSCs after seeding. The substitute was able to recapitulate in shape and function the original esophageal muscle layer.

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Catry, Jonathan, Minh Luong-Nguyen, Lousineh Arakelian, Tigran Poghosyan, Patrick Bruneval, Thomas Domet, Laurent Michaud et al. « Circumferential Esophageal Replacement by a Tissue-engineered Substitute Using Mesenchymal Stem Cells ». Cell Transplantation 26, n^o 12 (décembre 2017) : 1831–39. http://dx.doi.org/10.1177/0963689717741498.

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Tissue engineering appears promising as an alternative technique for esophageal replacement. Mesenchymal stem cells (MSCs) could be of interest for esophageal regeneration. Evaluation of the ability of an acellular matrix seeded with autologous MSCs to promote tissue remodeling toward an esophageal phenotype after circumferential replacement of the esophagus in a mini pig model. A 3 cm long circumferential replacement of the abdominal esophagus was performed with an MSC-seeded matrix (MSC group, n = 10) versus a matrix alone (control group, n = 10), which has previously been matured into the great omentum. The graft area was covered with an esophageal removable stent. A comparative histological analysis of the graft area after animals were euthanized sequentially is the primary outcome of the study. Histological findings after maturation, overall animal survival, and postoperative morbidity were also compared between groups. At postoperative day 45 (POD 45), a mature squamous epithelium covering the entire surface of the graft area was observed in all the MSC group specimens but in none of the control group before POD 95. Starting at POD 45, desmin positive cells were seen in the graft area in the MSC group but never in the control group. There were no differences between groups in the incidence of surgical complications and postoperative death. In this model, MSCs accelerate the mature re-epitheliazation and early initiation of muscle cell colonization. Further studies will focus on the use of cell tracking tools in order to analyze the becoming of these cells and the mechanisms involved in this tissue regeneration.

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Kędzierska, Zofia, Klaudia Dadas, Urszula Żurek, Ignacy Tołwiński, Aleksandra Świercz, Dominika Małachowska, Hubert Ciecierski-Koźlarek, Klaudia Antkowiak et Kateryna Shved. « Long-gap esophageal atresia : management, most frequent complications, and expert recommendations – review of literature ». Journal of Education, Health and Sport 45, n^o 1 (24 août 2023) : 310–26. http://dx.doi.org/10.12775/jehs.2023.45.01.022.

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Introduction and aim of the study. Long-gap esophageal atresia (LGEA) is a congenital anomaly in which the gap between both ends of the esophagus exceeds three intervertebral spaces and is an esophageal atresia without air in the abdomen. The defect is both therapeutic and surgical challenge. This review aims at providing an overview of the most recent literature on the effective methods for treatment of LGEA, and the most frequent complications and experts’ recommendations on this subject. Material and methods. The systematic review was based on available data collected using PubMed database and the Google Scholar web search engine. Analysis of the literature. There is no consensus on the ideal technique for surgical treatment of LGEA. There are two possible approaches for opening the thorax – thoracotomy and thoracoscopy. The techniques stimulating esophageal elongation include external and internal traction techniques, magnetic compression anastomosis and intramural botulinum type A toxin injection. Replacement methods are a viable option when it is impossible to preserve the native esophagus. Decellularized matrices seem to be promising in developing an esophageal substitute. Regardless of the surgical approach a common complication of surgical treatment is anastomotic stenosis which requires further surgical interventions. Conclusion. Elongation techniques are effective in approximation of the proximal and distal esophagus. The future lies with tissue engineering and inventing an off-the-shelf esophageal substitute. The centralization of treatment is recommended. After discharge from hospital interdisciplinary outpatient assessment and care is required. Further prospective studies are needed to determine the optimal mode of treatment and prevent complications associated with LGEA.

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Sato, Yu, Tatsuo Kanda, Shin-ichi Kosugi, Takashi Ishikawa, Tetsuya Tada et Toshifumi Wakai. « Pyloroantrectomy and Pedunculated Short Gastric-Tube Interposition in Esophageal Carcinoma Patients Associated With Early Gastric Adenocarcinoma ». International Surgery 104, n^o 3-4 (1 mars 2020) : 143–48. http://dx.doi.org/10.9738/intsurg-d-16-00011.1.

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Gastric carcinoma is one of the most common secondary malignancies in esophageal cancer patients. We herein report our surgical procedure for esophageal reconstruction in esophageal cancer patients associated with synchronous or metachronous early gastric adenocarcinoma. Gastric adenocarcinoma was removed by pyloroantrectomy with preservation of the right gastroepiploic artery and vein, and a pedunculated short gastric tube was used as an esophageal substitute in a Roux-en-Y fashion. Surgical data of 6 esophageal cancer patients who underwent this type of surgery between 1993 and 2012 were analyzed. Three patients had synchronous early gastric carcinoma and the remaining 3 patients had metachronous early gastric adenocarcinoma. The gastric tube was easily pulled up to the neck and no problems occurred during this procedure. Postoperative complications, including leakage of esophagogastrostomy, acute respiratory failure, and diffuse peritonitis, were observed in 3 patients. No patients suffered from necrosis of the gastric tube. Although 3 patients died of other diseases, gastric cancer recurrence has not been observed to date. Despite the need for precaution to ensure technical safety, pyloroantrectomy and esophageal reconstruction using a pedunculated short gastric-tube are oncologically feasible as a potential curative surgery for esophageal cancer patients with early gastric adenocarcinoma.

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Mishra, Haris Chandra, Jyotiranjan Mohapatra, Sashibhusan Dash et Sanghamitra Dash. « Surgical management of upper cervical esophagus stricture caused by ingestion of corrosive substances – a single-center experience ». European Journal of Clinical and Experimental Medicine 22, n^o 1 (30 mars 2024) : 88–93. http://dx.doi.org/10.15584/ejcem.2024.1.16.

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Introduction and aim. Corrosive strictures of the upper cervical esophagus and hypopharynx are hard to treat in the operating room because there is a high chance of aspiration during swallowing after a high-up or proximal esophageal anastomosis. In this cases, we aimed to evaluate the role of intraoperative dilatation of the proximal hypopharyngeal and cervical esophageal stumps during surgery. Material and methods. Patients who underwent surgery and had upper cervical esophageal and hypopharyngeal strictures from corrosive substance ingestion were included. Results. Out of total 27 patients, 10 had a cricopharyngeal or proximal cervical esophageal stricture with a long segment tho racic esophageal stricture that was treated with intra-operative dilatation (IOD) of the proximal hypopharyngeal stump. IOD was done in two cases with Hegar’s dilator and in three cases with wire-guided Savary Gillard dilators. In 74% (20/27) of the cases, the colon was frequently used as an esophageal substitute, while the stomach was only used in 10 cases. On follow-up, none of them developed repeated aspirations or required a tracheotomy. Conclusion. IOD of the proximal hypopharyngeal and cervical esophageal stumps during surgery for corrosive upper cervi cal esophageal or cricopharyngeal strictures helps to save the proximal stump and avoid frequent hospital stays and multiple surgeries.

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Fürst, H., T. P. Hüttl, F. Löhe et F. W. Schildberg. « German experience with colon interposition grafting as an esophageal substitute* ». Diseases of the Esophagus 14, n^o 2 (avril 2001) : 131–34. http://dx.doi.org/10.1046/j.1442-2050.2001.00170.x.

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Moreno-Osset, Eduardo, Manuel Tomas-Ridocci, Francisco Paris, Francisco Mora, Angel Garcia-Zarza, Ramon Molina, Juan Pastor et Adolfo Benages. « Motor Activity of Esophageal Substitute (Stomach, Jejunal, and Colon Segments) ». Annals of Thoracic Surgery 41, n^o 5 (mai 1986) : 515–19. http://dx.doi.org/10.1016/s0003-4975(10)63031-7.

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Gutschow, Christian A., Jean-Marie Collard, Renato Romagnoli, Jean-Marie Michel, Mauro Salizzoni et Arnulf H. Hölscher. « Bile exposure of the denervated stomach as an esophageal substitute ». Annals of Thoracic Surgery 71, n^o 6 (juin 2001) : 1786–91. http://dx.doi.org/10.1016/s0003-4975(01)02535-8.

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Schilling, M. K., Ch Maurer et M. W. Buechler. « Fundus rotation gastroplasty as esophageal substitute : Microcirculatory and clinical results ». Gastroenterology 108, n^o 4 (avril 1995) : A1245. http://dx.doi.org/10.1016/0016-5085(95)29274-8.

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Reynolds, Marleta. « Motor activity of esophageal substitute (stomach, jejunal and colon segments) ». Journal of Pediatric Surgery 22, n^o 1 (janvier 1987) : 89. http://dx.doi.org/10.1016/s0022-3468(87)80049-0.

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Aikawa, M., M. Miyazawa, K. Takase, Y. Ueno, K. Okada, Y. Toshimitsu, K. Okamoto, I. Koyama et Y. Ikada. « Development of an Esophageal Regenerative Therapy with a Bioabsorbable Polymer Substitute ». Nihon Kikan Shokudoka Gakkai Kaiho 62, n^o 2 (2011) : 86. http://dx.doi.org/10.2468/jbes.62.86.

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Collins, Jovian, Mark O. Tessaro et Terrance McGovern. « Esophageal bougienage in the emergency department with a substitute Hurst dilator ». American Journal of Emergency Medicine 38, n^o 1 (janvier 2020) : 163.e3–163.e5. http://dx.doi.org/10.1016/j.ajem.2019.158411.

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Collard, Jean-Marie, Renato Romagnoli, Jean-Bernard Otte et Paul-Jacques Kestens. « The Denervated Stomach as an Esophageal Substitute Is a Contractile Organ ». Annals of Surgery 227, n^o 1 (janvier 1998) : 33–39. http://dx.doi.org/10.1097/00000658-199801000-00005.

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Gutschow, Christian, Jean-Marie Collard, Renato Romagnoli, Mauro Salizzoni et Arnulf Hölscher. « Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time ». Annals of Surgery 233, n^o 4 (avril 2001) : 509–14. http://dx.doi.org/10.1097/00000658-200104000-00005.

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Yekrang, Javad, Dariush Semnani et Saeed Karbasi. « Optimizing the mechanical properties of a bi-layered knitted/nanofibrous esophageal prosthesis using artificial intelligence ». e-Polymers 16, n^o 5 (1 septembre 2016) : 359–71. http://dx.doi.org/10.1515/epoly-2016-0146.

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AbstractThe esophagus is a tubular multi-layer organ that carries the food bolus and liquids from the mouth to the stomach. Esophageal prostheses and scaffolds should have the appropriate mechanical and strain properties in the longitudinal and circumferential directions. A novel bi-layered esophageal prosthesis was produced using knitted tubular silk fabric and a coating of polyurethane (PU) nanofibers. The optimization process was performed in two steps. First, 12 different tubular structures of knitted silk fabrics were produced and mechanical properties were measured in both directions. The mechanical properties were optimized using an artificial neural network (ANN) and a genetic algorithm (GA) and the optimum knitted structure was produced as a substrate for coating with PU nanofibers. In second step, 20 different samples were produced by electrospinning the PU nanofibers at different process conditions (collector speed, feeding rate) on the optimized structure of the knitted fabric. Finally, the elastic properties of the bi-layered tubular structures were measured and optimized by the ANN and GA methods. Results presented show that the optimized structure of the esophageal prosthesis had proper mechanical properties similar to the esophagus. Such a structure can be used as a substitute in esophageal disorders.

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Izbéki, Ferenc. « Synchronous electrogastrographic and manometric study of the stomach as an esophageal substitute ». World Journal of Gastroenterology 11, n^o 8 (2005) : 1172. http://dx.doi.org/10.3748/wjg.v11.i8.1172.

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Lee, Sang Hyuk, Sang Hoon Lee, Ho Young Yoon et Choong Bai Kim. « Use of the Stomach as an Esophageal Substitute after Total Pharyngolaryngoesophagectomy for Treating Cervical Esophageal Cancer or Hypopharyngeal Cancer ». Journal of the Korean Gastric Cancer Association 7, n^o 4 (2007) : 200. http://dx.doi.org/10.5230/jkgca.2007.7.4.200.

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Patil, Revati, Dadasaheb Akolkar, Darshana Patil, Sewanti Limaye, Raymond Page, Timothy Crook, Vineet Datta et al. « Encyclopedic liquid biopsies for guideline-compliant diagnostic work-up in gastrointestinal cancers. » Journal of Clinical Oncology 38, n^o 4_suppl (1 février 2020) : 799. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.799.

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799 Background: Definitive diagnosis of gastrointestinal (GI) malignancies is reliant on histopathological examination of tumor tissue obtained by invasive biopsies. However, invasive biopsies are associated with procedural risks, complications and expenses. A non-invasive technique for diagnosis of GI cancers is presently unavailable. Here we present a non-invasive diagnostic approach for GI cancers based on immunocytochemical (ICC) profiling of Circulating Tumor Associated Cells (C-TAC) enriched from peripheral blood. Methods: We collected 15 mL peripheral blood from 1052 patients with known diagnosis of Ca Oesophagus (244), Ca Stomach (170) and Ca Colorectum (638) and with histopathological information available from prior tissue analysis. CTACs were harvested following negative enrichment. C-TACs were identified by immunostaining with EpCAM and panCK. Deep ICC characterization was carried out in a subset of 203 samples (100 colorectal, 19 Gastric and 84 Esophageal) using organ specific markers. A subset of 19 samples from Gastric and 94 samples Esophageal cancers were profiled for Her2 and PD-L1 status. Results: C-TACs could be identified and enriched in 1012 out of 1052 patients (96.2% overall sensitivity). Immunostaining for organ-specific markers was possible in all 203 (100%) samples. Her2 positivity was observed in 2/19 Gastric and 19/84 Esophageal samples. PD-L1 (22C3) positivity was observed in 5/19 Gastric and 32/84 Esophageal samples while PD-L1 (28-8) positivity was observed in 2/19 Gastric and 16/84 Esophageal samples. Conclusions: Our results show that ICC profiling of C-TACs can provide necessary diagnostic information non-invasively to substitute conventional procedures dependent on tissue extraction. This approach fulfils most clinical decision-making requirements in GI malignancies.

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Poghosyan, T., R. Sfeir, L. Michaud, P. Bruneval, M. Luong-Nguyen, T. Dommet, V. Vanneaux et al. « P-31 : Esophageal Replacement by a Tissue Engineered Substitute in a Porcine Model ». Diseases of the Esophagus 29, n^o 3 (1 avril 2016) : 298. http://dx.doi.org/10.1093/dote/29.3.298.

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Karaho, Takehiro, Tetsuya Satoh, Junko Nakajima, Takeshi Nakayama et Naoyuki Kohno. « Can mano-videoendoscopy substitute for videofluorography in evaluation of upper esophageal sphincter function ? » Acta Oto-Laryngologica 135, n^o 2 (décembre 2014) : 187–92. http://dx.doi.org/10.3109/00016489.2014.969384.

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Liu, Yu-Chih, Yau-Lin Tseng, Ming-Ho Wu, Wu-Wei Lai, I. Ling Hsu, Yi-Ting Yen et Jia-Ming Chang. « Ileocolon Graft Pedicled on Ileocolic Artery : An Alternative Esophageal Substitute for Corrosive Injury ». Annals of Thoracic Surgery 84, n^o 1 (juillet 2007) : 295–96. http://dx.doi.org/10.1016/j.athoracsur.2007.02.065.

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Aiolfi, Alberto, Emanuele Asti, Gianluca Bonitta, Stefano Siboni et Luigi Bonavina. « Esophageal Resection for End-Stage Achalasia ». American Surgeon 84, n^o 4 (avril 2018) : 506–11. http://dx.doi.org/10.1177/000313481808400422.

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Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms “achalasia,” “end-stage achalasia,” “esophagectomy,” and “esophageal resection.” Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.

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Ichino, Martina, Lorenza Pugni, Andrea Zanini, Anna Morandi, Fabio Mosca et Francesco Macchini. « Possible Approach to Esophageal Lung with Long Tracheobronchial Gap ». European Journal of Pediatric Surgery Reports 07, n^o 01 (janvier 2019) : e28-e31. http://dx.doi.org/10.1055/s-0039-1692407.

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AbstractEsophageal lung is a rare bronchopulmonary foregut malformation characterized by an anomalous origin of one of the main bronchi which arises from the esophagus. Less than 30 cases are reported in the literature. Therefore, there are no standardized guidelines for the treatment of this condition. We report a case of right esophageal lung diagnosed in a neonate. The patient was treated with thoracoscopic closure of the ectopic main bronchus in the neonatal period, followed by delayed pneumonectomy at 5 months of age. No prosthetic substitute was implanted in the ipsilateral hemithorax after pneumonectomy. The patient is now 4 years old and doing well, postpneumonectomy syndrome was never observed. Our strategy and the possible alternatives are discussed here.

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Collard, J. M., R. Romagnoli, L. Goncette et C. Gutschow. « Whole stomach with antro-pyloric nerve preservation as an esophageal substitute : an original technique ». Diseases of the Esophagus 17, n^o 2 (1 juin 2004) : 164–67. http://dx.doi.org/10.1111/j.1442-2050.2004.00395.x.

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Collard, Jean-Marie, Renato Romagnoli, Jean-Bernard Otte et Paul-Jacques Kestens. « Erythromycin Enhances Early Postoperative Contractility of the Denervated Whole Stomach as an Esophageal Substitute ». Annals of Surgery 229, n^o 3 (mars 1999) : 337–43. http://dx.doi.org/10.1097/00000658-199903000-00006.

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Fox, Victor L., David L. Carr‐Locke, Pamela J. Connors et Alan M. Leichtner. « Endoscopic Ligation of Esophageal Varices in Children ». Journal of Pediatric Gastroenterology and Nutrition 20, n^o 2 (février 1995) : 202–8. http://dx.doi.org/10.1002/j.1536-4801.1995.tb11535.x.

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SummarySeven consecutive patients presenting acutely with suspected variceal hemorrhage underwent endoscopic variceal ligation (EVL) of esophageal varices. Active bleeding had ceased by the time of the initial EVL session in all patients, although active variceal hemorrhage was controlled by EVL in one patient during a sub‐sequent episode of bleeding. Treatment sessions were repeated at approximately monthly intervals until varices were reduced in size to grade 1 (<4 mm diameter) or eradicated. All patients had portal hypertension secondary to intrahepatic disease. Patient age ranged from 2.4 to 14.5 years (mean, 8.5 years). One patient underwent successful liver transplantation 1 week after the initial treatment session. The remaining six patients required a mean (±SD) of 4.0 ± 1.3 treatment sessions for elimination of varices. One episode of recurrent variceal hemorrhage and one episode of treatment‐related hemorrhage occurred in two separate patients. Transient, mild dysphagia or odynophagia occurred in all patients. No other complications were reported during a mean (±SD) follow‐up period of 13.8 ± 4.6 months (range, 8–20 months). Recurrent varices were seen in three of four (75%) patients returning for follow‐up endoscopy between 5 and 8 months from initial eradication. All underwent repeat EVL without complication. Endoscopic variceal ligation may be a suitable substitute for sclerotherapy in children with bleeding esophageal varices.

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Ueno, Masaki, Syuusuke Haruta, Tsuyoshi Tanaka, Yu Okura, Toshiro Iizuka et Harushi Udagawa. « RA05.05 : STOMACH PRESERVED ILEOCOLIC INTERPOSITION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER ». Diseases of the Esophagus 31, Supplement_1 (1 septembre 2018) : 28. http://dx.doi.org/10.1093/dote/doy089.ra05.05.

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Abstract Background A stomach is the first choice as an esophageal substitute after esophagectomy for cancer. In case with a history of gastrectomy, concurrent gastric disease, the ileo-colon is used as an esophageal substitute in our hospital. From 2007, as a method of preservation of the gastrointestinal function, we have provided the reconstruction of stomach preserved ileo-colic interposition. Methods 1990–2017.12, 227 patients underwent colon interposition after esophagectomy with extended lymphadenectomy. Until 1997, we selected the colon graft based on colon vessel finding during surgery. From 1998, we assumed ileo-colon first choice. From 2007, we started stomach preserved ileo-colic interposition. Between 2007 and 2017, we performed this method in 108/142 colon interposition patients. We examined these 108 patients to know the recent result of ileo-colon interposition. Results An average of 108 patients is 61 years. The cases without preoperative treatment was 38 cases (35%). Endoscopic resection was done in 23 cases (21%). 38 received preoperative chemo and 9 CRT. Clinical TNM was I/II/III/IV = 62/20/24/2. We performed lymphadenectomy with three field in 70 and two in 38. Route of reconstruction was retrosternal in 99(92%), a posterior mediastinal in 8. Microvascular anastomosis was conducted in one. The anastomosis of all cases performed hand-sewn end-to-side anastomosis in neck. The incidence of postoperative morbidity is one patient had anastomotic minor leakage (1%), one had pneumonia to need intubation. 4 patients experienced bowel obstruction, 1 required surgery. Endoscopy had done 4–12 month later, there were no patients have reflux esophagitis or anastomotic stenosis. 12 patients had colon-gastric anastomotic ulcer. PPI was started. The weight rate of decline of the 12 months after surgery was an average of 9%. 32% patients have diarrhea. Conclusion Stomach preserved ileo-colic interposition after esophagectomy with extended lymphadenectomy is feasible and have a favorable outcome. Keep up long-term quality of life and decrease in complications after the long-term progress is expected. Disclosure All authors have declared no conflicts of interest.

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Poghosyan, Tigran, Rony Sfeir, Laurent Michaud, Patrick Bruneval, Thomas Domet, Valerie Vanneaux, Minh Luong-Nguyen et al. « Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute : An experimental study in minipigs ». Surgery 158, n^o 1 (juillet 2015) : 266–77. http://dx.doi.org/10.1016/j.surg.2015.01.020.

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Dessanti, Antonio, Diego Falchetti, Vincenzo Di Benedetto et Maria Grazia Scuderi. « Pedicled jejunal interposition as esophageal substitute in pediatric patients. Technical considerations and long-term results ». Journal of Pediatric Surgery Case Reports 64 (janvier 2021) : 101744. http://dx.doi.org/10.1016/j.epsc.2020.101744.

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Tolia, Vasundhara, et Ralph E. Kauffman. « Comparison of Evaluation of Gastroesophageal Reflux in Infants Using Different Feedings During Intraesophageal pH Monitoring ». Journal of Pediatric Gastroenterology and Nutrition 10, n^o 4 (mai 1990) : 426–29. http://dx.doi.org/10.1002/j.1536-4801.1990.tb10024.x.

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SummaryThe effect of two different types of feedings on results of esophageal pH monitoring was prospectively studied in 49 infants undergoing evaluation for gastro‐esophageal reflux (GER). Infants were randomly assigned to receive either apple juice (AJ) or formula for the first feeding during extended pH monitoring (EPM). Each infant received the alternate liquid for the second feeding. During the rest of the monitoring period, infants received formula feedings. The percentage of time that esophageal pH was less than 4.0 following both types of feedings and the percentage of time that pH was lower than 5.0 following formula feedings were determined. Following AJ feeding, the mean percentage of time pH was less than 4.0 was 43.8% in contrast to 5.1% following formula feeding. However, following formula feeding, pH was less than 5.0 35.7% of time, similar to the percentage of time pH was less than 4.0 after AJ feeding. Ability to detect GER with short‐term monitoring after the two feedings was compared to detection following extended monitoring. Detection of GER with short‐term monitoring following AJ feeding correlated well with extended monitoring (r = 0.67; p < 0.001). There was a weaker, although significant, correlation between short‐term monitoring following formula feeding using pH less than 5.0 as the reflux criterion and extended monitoring (r = 0.3; p < 0.01). We conclude that outpatient GER evaluation with intraesoph‐ageal pH monitoring during a feeding interval following an AJ feeding may serve as an acceptable substitute for extended pH monitoring when it is not practical or desirable to admit the patient to the hospital.

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Hung, Pang-Chieh, Hsuan-Yu Chen, Yu-Kang Tu et Yung-Shuo Kao. « A Comparison of Different Types of Esophageal Reconstructions : A Systematic Review and Network Meta-Analysis ». Journal of Clinical Medicine 11, n^o 17 (26 août 2022) : 5025. http://dx.doi.org/10.3390/jcm11175025.

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Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high anastomosis leakage rates among these three types of conduits has not been reported. The aim of this network meta-analysis was to investigate the rate of anastomotic leakage (AL) among the three procedures to determine the best esophageal substitute or the future direction for improving the conventional gastric pull-up (GPU). Methods: We searched PubMed, Cochrane, and Embase databases. We included esophageal cancer patients receiving esophagectomy and excluded patients with other cancer. The random effect model was used in this network meta-analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment of studies in the network meta-analysis, and funnel plots were used to evaluate publication bias. The primary outcome is anastomosis leakage; the secondary outcomes are stricture formation, length of hospital stays, and mortality rate. Results: Nine studies involving 1613 patients were included in this network meta-analysis. The trend results indicated the following. Regarding anastomosis leakage, free jejunal flap was the better procedure; regarding stricture formation, colon interposition was the better procedure; regarding mortality rate, free jejunal flap was the better procedure; regarding length of hospital stay, gastric pull-up was the better treatment. Discussion: Overall, if technically accessible, free jejunal flap is a better choice than colon interposition when gastric conduit cannot be used, but further study should be conducted to compare groups with equal supercharged patients. In addition, jejunal flap (JF) cannot replace traditional gastric pull-up (GPU) due to technical complexities, more anastomotic sites, and longer operation times. However, the GPU method with the supercharged procedure would be a possible solution to lower postoperative AL. The limitation of this meta-analysis is that the number of articles included was low; we aim to update the result when new data are available. Funding: None. Registration: N/A.

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Hamahata, Natsumi, Ryota Sato, Kimiyo Yamasaki, Sophie Pereira et Ehab Daoud. « Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec ». Journal of Mechanical Ventilation 1, n^o 1 (1 septembre 2020) : 8–13. http://dx.doi.org/10.53097/jmv.10003.

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Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure

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Mori, N., H. Fujita, S. Sueyoshi, Y. Aoyama, T. Yanagawa et K. Shirouzu. « Helicobacter pylori infection influences the acidity in the gastric tube as an esophageal substitute after esophagectomy ». Diseases of the Esophagus 20, n^o 4 (1 août 2007) : 333–40. http://dx.doi.org/10.1111/j.1442-2050.2007.00718.x.

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Donoso, Felipe, Anna Beckman, Andrei Malinovschi et Helene Engstrand Lilja. « Predictors of histopathological esophagitis in infants and adolescents with esophageal atresia within a national follow-up programme ». PLOS ONE 17, n^o 4 (15 avril 2022) : e0266995. http://dx.doi.org/10.1371/journal.pone.0266995.

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Purpose Esophageal atresia (EA) is a congenital anomaly of the foregut. Although the survival has improved over the years there is a significant gastrointestinal morbidity affecting physical function and health-related quality of life. The aims of the study were to identify and evaluate predictors of histopathological esophagitis in infants and adolescents with EA. Methods Single centre, cross-sectional study including one and 15-year-old patients operated for EA that participated in the national follow-up programme between 2012 and 2020 according to a pre-established protocol including upper endoscopy with oesophageal biopsies and 24h-pH-test. Data was collected from patients’ medical records and pH-analysis software. Regression models were used to identify predictors of histopathological oesophagitis. Possible predictors were abnormal reflux index, endoscopic esophagitis, hiatal hernia, symptoms of gastroesophageal reflux (GER) and age. Results 65 patients were included, 47 children and 18 adolescents. All children were treated with PPI during their first year of life. Symptoms of GER were reported by 13 (31.7%) of the infant’s caregivers, 34 of the children (72.3%) had abnormal reflux index and 32 (68.1%) had histopathological esophagitis. The corresponding numbers for adolescents were 8 (50%), 15 (83.3%) and 10 (55.6%). We found no significant associations between histopathological esophagitis and endoscopic esophagitis, symptoms of GER, hiatus hernia or age group. Abnormal reflux index was an independent predictor of histopathological esophagitis. Seven patients with normal reflux index had histopathological esophagitis, all grade I. Conclusions We found a high prevalence of histopathological esophagitis despite PPI treatment in accordance with recommendations. No significant difference between the two age groups was seen. Abnormal reflux index was an independent predictor of histopathological esophagitis. However, we cannot recommend the use of pH-metry as a substitute for esophageal biopsies; future studies are needed to elucidate if esophageal biopsies might be postponed in infants with normal reflux index.

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Hangaard, Martin H., et Michael B. Mortensen. « Colon Interposition for Esophageal Reconstruction in Cancer Patients ». International Surgery 103, n^o 5-6 (1 mai 2018) : 238–47. http://dx.doi.org/10.9738/intsurg-d-17-00119.1.

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Objective: The aim of this study was to report our experience with colon interposition (COI) and to compare the results with an extensive review of the COI literature. Summary of Background Data: The stomach is the first choice as an esophageal substitute following esophagectomy in cancer patients, while COI is reserved for patients where the stomach is not available or must be included in the resection due to cancer. Methods: We retrospectively reviewed the records of cancer patients undergoing colon interposition from 2006 to 2017. Outcomes were compared with an extensive review of the literature published between 2000 and 2017. Results: A total of 13 patients underwent planned COI. Mortality was zero and overall morbidity was 53%; 4 patients suffered from leakage and 2 patients from strictures. None of the patients suffered from necrosis of the interponat and there was no need for subsequent redundancy operations. The extensive review identified 23 publications. Overall study grading was low (grade C). Only 3 studies were prospective, no randomized studies were found, and many outcomes were poorly defined. The rates for 30-day and in-hospital mortality were 1% and 2%, respectively. Overall morbidity was 43%. The reported number of leakages, strictures, necrosis of the interponat, and redundancy operations varied between 0% and 50%, 0% and 21%, 0% and 9%, and 0% and 2%, respectively. Conclusions: COI is a complex technique that is necessary in a relatively small group of selected patients after esophagectomy for cancer. Prospective and comparative studies with strict outcome definitions, long-term follow up, and patient reported outcome measures are lacking.

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Smith, T., P. Couillard, P. Hruska, P. McBeth et J. Kortbeek. « P.021 Esophageal cooling for hypoxic ischemic encephalopathy : a feasibility study ». Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, s1 (juin 2019) : S19. http://dx.doi.org/10.1017/cjn.2019.121.

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Background: Targeted temperature management (TTM) is a recognized treatment to decrease mortality and improve neurological functionin hypoxic ischemic encephalopathy (HIE). An esophageal cooling device (ECD) has been studied in animal models but human data is limited. ECD appear to offer similar benefits to intravascular cooling catheters with potentially less risk to the patient. We studied whether the ECD could act as a substitute for intravascular cooling catheters. Methods: Eight ICU patients admitted following cardiac arrest who required TTM were enrolled prospectively. The primary outcome measures were timeliness of insertion, ease of insertion, user Likert ratings, time to achieve a target temperature of 36˚C and time target temperature was maintained within 0.5˚C of the 36˚C goal for 24 hours using an ECD. Results: Time to reach target temperature 0 min to 540 min. ECD appeared to be effective at maintaining a target temperature of 36˚C for most patients. In general, the catheter was easy to insert and use. Conclusions: For patients requiring TTM, use of an ECDadequately allowed for TTM goalsto be achieved and maintained. Overall user evaluationwas positive.

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Samuel, Madan, et David M. Burge. « Gastric tube interposition as an esophageal substitute : Comparative evaluation with gastric tube in continuity and gastric transposition ». Journal of Pediatric Surgery 34, n^o 2 (février 1999) : 264–69. http://dx.doi.org/10.1016/s0022-3468(99)90187-2.

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Cariati, Andrea, Alessandro Casano, Antonello Campagna, Erminio Cariati et Gianluigi Pescio. « Prognostic factors influencing morbidity and mortality in esophageal carcinoma ». Revista do Hospital das Clínicas 57, n^o 5 (septembre 2002) : 201–4. http://dx.doi.org/10.1590/s0041-87812002000500002.

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PURPOSE: In 1980, operative mortality for esophageal resection was 29%. Over the last 15 years, technical and critical care improvements contributed to the reduction of postoperative mortality rate to 8%. The aim of this study is to analyze retrospectively the role of different factors (surgical procedure, stage of the disease, and anesthetic risk) on the postoperative mortality of 63 patients that underwent esophagectomy with gastric interposition for cancer. METHODS: Seventy-two patients underwent esophagectomy. The stomach was the esophageal substitute in 63 cases. Surgical procedures included transthoracic esophagectomy in 49 patients and transhiatal esophagectomy in 14 cases. Among the 49 transthoracic esophagectomy patients, there were 18 patients with a high anesthetic risk (ASA III). Among the patients that underwent transhiatal esophagectomy, there were 10 patients with a high anesthetic risk (ASA III). RESULTS: The operative mortality rate was 14% (2/14) in transhiatal esophagectomy group and 22% (11/49) in transthoracic esophagectomy group (P = ns). The postoperative mortality of patients with a high anesthetic risk (ASA III) was 47% (8/17) after transthoracic esophagectomy and 10% (1/10) after transhiatal esophagectomy (P <0.05). DISCUSSION: In our experience, the operative mortality was nearly 18% (16.6% after transhiatal esophagectomy and 20.8% after transthoracic esophagectomy). Among the patients with a high anesthetic risk (ASA III) that underwent surgery, the postoperative mortality was significantly lower after transhiatal esophagectomy (10%) compared to transthoracic esophagectomy (47%) (P <0.05).

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Daikhes, N. A., S. S. Reshulskiy, M. L. Isaeva et V. V. Vinogradov. « Objective evaluation of the pharyngoesophageal segment as a source of substitute phonation in patients after total laryngectomy ». Siberian journal of oncology 22, n^o 6 (2 janvier 2024) : 55–63. http://dx.doi.org/10.21294/1814-4861-2023-22-6-55-63.

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The study aimed to identify objective predictors of the successful voice rehabilitation after total laryngectomy to select the optimal method of voice restoration.Material and Methods. The study included 60 laryngectomized male patients who were stratified into 2 equal groups depending on the patient’s choice of voice restoration: tracheoesophageal puncture or esophageal voice. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment was carried out using the diagnostic procedures, such as: fiberoptic endoscopic evaluation of swallowing, high-speed video endoscopy, and high-resolution pharyngoesophageal manometry. The results of examination of the pharyngoesophageal segment were compared with the results of voice rehabilitation.Results. A significant difference in the resting pressure in the pharyngoesophageal segment between patients with successful and unsuccessful voice rehabilitation was found. The resting pressure in the pharyngoesophageal segment was higher in patients with unsuccessful voice rehabilitation than in patients with successful voice rehabilitation. Among patients with failed voice rehabilitation, 64 % had pseudodiverticula, 25 % had cicatricial strictures and 11 % had pharyngospasm. Pseudodiverticula were found only in patients who underwent vertical or apparatus pharyngeal closure. We described vibrating patterns of substitute phonation in laryngectomized patients and identified 5 different types of pseudoglottis. No significant differences between the methods of substitute phonation were found.Conclusion. The state of pharyngoesophageal segment is an objective predictor of successful substitute phonation and depends on the surgical technique of pharyngeal closure, the volume of cancer treatment and the course of the postoperative period. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment using fiberendoscopic, fuoroscopic studies and highresolution pharyngoesophageal manometry allows prediction of voice rehabilitation outcomes.

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Sugiura, Teiichi, Hoichi Kato, Yuji Tachimori, Hiroyasu Igaki, Hajime Yamaguchi et Yukihiro Nakanishi. « Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy1 1No competing interests declared. » Journal of the American College of Surgeons 194, n^o 5 (mai 2002) : 578–83. http://dx.doi.org/10.1016/s1072-7515(02)01135-3.

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Predescu, Irina, Dragos Predescu, Codrut Sarafoleanu et Silviu Constantinoiu. « Considerations on cervical anastomoses in postcaustic esophageal reconstruction ». Romanian Journal of Rhinology 5, n^o 20 (1 décembre 2015) : 215–23. http://dx.doi.org/10.1515/rjr-2015-0025.

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Abstract Background. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one. Material and methods. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the “Sfanta Maria” Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients. Results. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent. Conclusion. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical “artifices” and of the necessary therapeutic refinements adapted to each individual case.

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Kolho, Kaija‐Leena, et Erkki Savilahti. « IgA Endomysium Antibodies on Human Umbilical Cord : An Excellent Diagnostic Tool for Celiac Disease in Childhood ». Journal of Pediatric Gastroenterology and Nutrition 24, n^o 5 (mai 1997) : 563–67. http://dx.doi.org/10.1002/j.1536-4801.1997.tb00652.x.

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Background:An improvement in screening for celiac disease has recently been described that uses human umbilical cord as a substitute for monkey esophagus to determine IgA endomysium antibodies in adults. As using monkey esophagus is ethically questionable for large‐scale screening, we studied whether substitution of umbilical cord would be suitable for pediatric patients as well.Methods:Serum from 53 children with untreated celiac disease, 22 in remission and 13 on challenge, were screened for antigliadin IgA, antigliadin IgG, and IgA reticulin antibodies, in addition to IgA endomysium antibodies tested both on monkey esophagus and on human umbilical cord. Controls included 20 patients with cow‐milk‐sensitive enteropathy, 23 with inflammatory bowel disease, and 23 with diabetes mellitus, and 48 patients who were biopsied to exclude celiac disease either because of positive gliadin antibody test or disturbed growth.Results:Sensitivity (0.94) and specificity (1.0) were similar for umbilical cord and esophageal determinations in active celiac disease. Both substrates detected identical positive cases and neither gave false‐positive results. In celiac patients on a gluten‐free diet, endomysium antibodies with either substrate were positive in seven identical cases and negative in 15 of 22 cases. Correlations with reticulin antibodies were comparable with human umbilical cord and monkey esophagus (0.83 and 0.85, respectively; Spearman Correlation Scction Pair‐Wise deletion).Conclusions:Human umbilical cord is an excellent substitute for monkey esophagus to determine endomysium antibodies in celiac diagnosis in children and adolescents.

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Daoud, Ehab, et Rebecca Shimabukuro. « Mechanical ventilation for the non-critical care trained practitioner. Part 1 ». Journal of Mechanical Ventilation 1, n^o 2 (1 décembre 2020) : 39–51. http://dx.doi.org/10.53097/jmv.10011.

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There have been a recent shortage of both critical care physicians and respiratory therapists with training in mechanical ventilation that is accentuated by the recent COVID-19 crisis. Hospitalists and primary care physicians find themselves more often dealing with and treating critically ill patients on mechanical ventilation without specific training. This two part review will try to explain and simplify some of the physiologic concepts of mechanical ventilation, strategies for managements of different diseases, monitoring, brief review of some of the common modes used for support and weaning during mechanical ventilation and to address some of the adverse effects associated with mechanical ventilation. We understand the complexity of the subject and this review would not be a substitute of seeking appropriate counselling, further training, and medical knowledge about mechanical ventilation. Further free resources are available to help clinicians who feel uncomfortable making decisions with such technology Keywords: Mechanical ventilation, Driving pressure, Compliance, Resistance, Capnometry, Dead space, ARDS, PEEP, auto-PEEP, Plateau pressure, esophageal balloon

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Takemura, Masashi, Masayuki Higashino, Shinya Tanimura, Yosuke Fukunaga, Yoshinori Tanaka et Yushi Fujiwara. « A case of using the remnant stomach as substitute after esophagectomy for esophageal cancer with history of distal gastrectomy ». Esophagus 4, n^o 3 (18 octobre 2007) : 121–24. http://dx.doi.org/10.1007/s10388-007-0117-9.

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Jain, Amit, Kishore Mangal et Atul Jindal. « Esophageal dilator as a substitute for the custom stylet to remove the intubating laryngeal airway after tracheal intubation in children ». Canadian Journal of Anesthesia/Journal canadien d'anesthésie 58, n^o 5 (5 février 2011) : 480–81. http://dx.doi.org/10.1007/s12630-011-9465-y.

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Hagen, Rudolf, Burkard Schwab et Sabine Marten. « Nasotracheal Airway-Oropharyngeal Alimentary Canal : A Microvascular Technique for Reconstruction of the Upper Airway after Total Laryngectomy ». Annals of Otology, Rhinology & ; Laryngology 104, n^o 4 (avril 1995) : 317–22. http://dx.doi.org/10.1177/000348949510400412.

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Every patient who has to be laryngectomized because of a carcinoma is concerned with the loss of his or her voice and the presence of a permanent tracheostoma in his or her neck. While various methods for producing a substitute voice are available (esophageal voice, voice devices, voice-shunt operations with or without voice prosthesis), it is usually impossible after laryngectomy to reconstruct a complete upper airway so that the tracheostoma can be closed. One potential method for reconstruction of the airway is its division into a nasotracheal airway and an oropharyngeal alimentary canal. Ten Alsatian dogs were laryngectomized, and a microvascularly anastomosed jejunal autograft was inserted as a junction between the tracheal stump and the circularly exposed nasopharynx, while the pharynx was reconstructed separately. One week postoperatively, oral feeding could be started again; at the same time breathing was possible via the reconstructed nasotracheal airway, which was kept open by insertion of a silicone tube. By means of this microvascular technique, a complete nasal airway could be reconstructed surgically after laryngectomy.

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EGAMI, Kaku, Akira WATANABE, Yasuhito SHIMIZU, Toshirou YOSHIYUKI, Takeshi MATSUDA, Zenya NAITO, Akira TAKAI et al. « ENTIRE ESOPHAGEAL CAUSTIC STRICTURE TREATED BY COLONIC SUBSTITUTE FOR TOTAL RESECTION OF THE ESOPHAGUS IN A CHILD -REPORT OF A CASE- ». Journal of the Japanese Practical Surgeon Society 49, n^o 2 (1988) : 304–9. http://dx.doi.org/10.3919/ringe1963.49.304.

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Poenar, Daniel Puiu, Guang Yang, Wei Keat Wan et Shilun Feng. « Low-Cost Method and Biochip for Measuring the Trans-Epithelial Electrical Resistance (TEER) of Esophageal Epithelium ». Materials 13, n^o 10 (20 mai 2020) : 2354. http://dx.doi.org/10.3390/ma13102354.

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Trans-epithelial electrical resistance (TEER) is a good indicator of the barrier integrity of epithelial tissues and is often employed in biomedical research as an effective tool to assess ion transport and permeability of tight junctions. The Ussing chamber is the gold standard for measuring TEER of tissue specimens, but it has major drawbacks: it is a macroscopic method that requires a careful and labor intensive sample mounting protocol, allows a very limited viability for the mounted sample, has large parasitic components and low throughput as it cannot perform multiple simultaneous measurements, and this sophisticated and delicate apparatus has a relatively high cost. This paper demonstrates a low-cost home-made “sandwich ring” method which was used to measure the TEER of tissue specimens effectively. This method inspired the subsequent design of a biochip fabricated using standard soft lithography and laser engraving technologies, with which the TEER of pig epithelial tissues was measured. Moreover, it was possible to temporarily preserve the tissue specimens for days in the biochip and monitor the TEER continuously. Tissue responses after exposure tests to media of various pH values were also successfully recorded using the biochip. All these demonstrate that this biochip could be an effective, cheaper, and easier to use Ussing chamber substitute that may have relevant applications in clinical practice.

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Ajani, Jaffer A., Milind Javle, Cathy Eng, David Fogelman, Jackie Smith, Barry Anderson, Chun Zhang et Kenzo Iizuka. « Phase I study of DFP-11207, a novel oral fluoropyrimidine with reasonable AUC and low Cmax and improved tolerability, in patients with solid tumors ». Investigational New Drugs 38, n^o 6 (6 mai 2020) : 1763–73. http://dx.doi.org/10.1007/s10637-020-00939-w.

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Summary 5-fluorouracil (5-FU) and 5-FU derivatives, such as capecitabine, UFT, and S-1, are the mainstay of chemotherapy treatment for gastrointestinal cancers, and other solid tumors. Compared with other cytotoxic chemotherapies, these drugs generally have a favorable safety profile, but hematologic and gastrointestinal toxicities remain common. DFP-11207 is a novel oral cytotoxic agent that combines a 5-FU pro-drug with a reversible DPD inhibitor and a potent inhibitor of OPRT, resulting in enhanced pharmacological activity of 5-FU with decreased gastrointestinal and myelosuppressive toxicities. In this Phase I study (NCT02171221), DFP-11207 was administered orally daily, in doses escalating from 40 mg/m2/day to 400 mg/m2/day in patients with esophageal, colorectal, gastric, pancreatic or gallbladder cancer (n = 23). It was determined that DFP-11207 at the dose of 330 mg/m2/day administered every 12 hours was well-tolerated with mild myelosuppressive and gastrointestinal toxicities. The pharmacokinetic analysis determined that the 5-FU levels were in the therapeutic range at this dose. In addition, fasted or fed states had no influence on the 5-FU levels (patients serving as their own controls). Among 21 efficacy evaluable patients, 7 patients had stable disease (33.3%), of which two had prolonged stable disease of >6 months duration. DFP-11207 can be explored as monotherapy or easily substitute 5-FU, capecitabine, or S-1 in combination regimens.

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Tefas, Cristian, Carina Boroș, Lidia Ciobanu, Teodora Surdea-Blaga, Alina Tanțău et Marcel Tanțău. « POEM : Five Years of Experience in a Single East European Center ». Journal of Gastrointestinal and Liver Diseases 29, n^o 3 (9 septembre 2020) : 323–28. http://dx.doi.org/10.15403/jgld-2676.

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Background and Aims: Achalasia is an esophageal motility disorder with many available therapies. Peroral endoscopic myotomy (POEM) is a therapeutic alternative to surgical myotomy, harboring significant potential short term advantages. Our aim was to analyze a single-series POEM’s learning curve, safety and efficiency over short, medium and long-terms in an East European Center. Methods: This observational, prospective study was carried out in the Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. Patients with symptomatic achalasia (Eckardt score>3) and pre-op evaluations consistent with the diagnosis of achalasia were included. All POEMs were performed by a highly skilled endoscopist. All patients were allowed to eat 48 hours after POEM. An esophagography was performed in all patients to exclude any leakage. The patients were asked to return for follow-up at established intervals: 1 month, 6 months, 12 months, and annually thereafter. Results: 136 patients were included with an average duration of symptomatology of 36.75 months. The procedure was technically successful in all patients, while a clinical success rate was achieved in 87.5% (n=119) of patients after one POEM session. The success rate was 92.64% after 6 months, 91.17% after one year, 88.9% after 2 years, and 87.5% after 3 years or more; 12.5% of patients required additional treatment. Eighteen patients (13.23%) presented major early complications. Gastroesophageal reflux disease was encountered in 16 patients immediately after POEM and in 22 patients at subsequent follow-ups. Conclusion: POEM is a safe and effective minimally invasive therapeutic option which can substitute surgical myotomy, having a high success rate and a low rate of adverse events in short, medium and long-term.

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