Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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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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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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Gastroesophageal reflux disease (GERD) in lung transplant recipients has gained increasing attention as a factor in allograft failure. There are few data on the impact of fundoplication on survival or lung function, and less on its effect on symptoms or quality of life. Patients undergoing fundoplication following lung transplantation from 1999 to 2005 were included in the study. ⋯ It may, however, slow progression to the more advanced stages of BOS. Reflux symptoms are well controlled and patients are highly satisfied. Whether performing fundoplication early post-lung transplant in selected patients can prevent BOS and improve long-term outcomes requires formal evaluation.
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Surgical resection is considered the gold standard treatment for esophageal cancer, with global cure rates ranging from 15 to 40%. Exclusive chemoradiotherapy has been used for patients with locally advanced esophageal carcinoma or without clinical conditions for esophagectomy, reaching a 5-year survival rate of up to 30%. However, locoregional control is poor, with local recurrence of 40-60%, being reported in the literature. ⋯ However, it presents with high surgical morbidity. Currently, salvage esophagectomy is considered the best available treatment to attempt cure in cases of tumor recurrence or persistence after exclusive chemoradiotherapy. All the other types of treatments are regarded as palliative with discouraging survival results.
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The number of esophageal mucosa mast cells (MCs) increases in allergic and inflammation conditions in the esophagus, but their role in these conditions is less clear. MCs are derived from bone marrow, migrate and mature in the peripheral tissues. Two subsets of MCs have been characterized as mucosal MC (MMC) and connective tissue MC (CTMC) defined by anatomic location, granule contents, and functions. ⋯ OVA in vitro challenge of the esophagus from sensitized guinea pig significantly decreased tryptase-positive MC subtypes MCtc and MCt, and released a significant amount of tissue histamine content. In conclusion, MCs in the guinea pig esophagus have unique features in immunophenotypes, distribution, and degranulation response to OVA challenge with the release of significant amounts of proteases and histamine into the tissue. These characteristics may indicate that OVA in vitro challenge in OVA-sensitized guinea pig esophagus could be a good model to study the role of esophageal MCs in allergic and inflammation conditions.