Active surveillance may be a viable option for select esophageal cancer patients achieving clinical complete response after neoadjuvant chemoradiation, but esophagectomy secures superior long-term survival. At 5 years, standard esophagectomy outperformed active surveillance with 1.74 vs 1.34 quality-adjusted life-years (QALYs) and 3.11 vs 2.41 life-years. Active surveillance showed short-term benefits, with a 2-year QALY gain […]
Category: Upper Gastrointestinal Tract
Early Feeding Safe After Esophagectomy for Cancer Patients
Early oral feeding after esophagectomy is safe and leads to better recovery outcomes. No increase in anastomotic leakage (risk ratio 0.89) noted. Early feeding significantly reduces pneumonia (risk ratio 0.66) and accelerates gastrointestinal recovery—first bowel movement and flatus occur about half a day earlier. Hospital stays shortened by nearly two days (1.89 days) with associated […]
Minimally invasive total gastrectomy matches open approach for cancer
Minimally invasive total gastrectomy (MITG) is as effective as open total gastrectomy (OTG) for locally advanced gastric cancer. 5-year overall survival rates: MITG at 87.3% vs. OTG at 83.0% (p = 0.398) Complication rates similar: MITG 10.6% vs. OTG 12.4% (p = 0.470) Consider MITG for suitable patients, balancing its lower blood loss with longer […]
Cost Drivers in Laparoscopic Hiatal Hernia Repair Identified
Understanding the factors affecting hospitalization costs in laparoscopic hiatal hernia repair can optimize surgical strategies and patient management. Material costs accounted for over 58% of total hospitalization expenses annually. Using absorbable sutures instead of tackers significantly reduced costs across all patient cost percentiles (up to $11,671 savings). Longer hospital stays raised costs and ICU use […]
Myotomy Methods Equal for Type III Achalasia Patients
Both per oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) deliver similar outcomes for treating Type III achalasia, suggesting flexibility in surgical approach. Success rates post-procedure were nearly identical: 88% for POEM (14 of 16) vs. 87% for LHM (26 of 30), with p=0.94. Re-intervention rates were also similar: 25% for POEM and 16.7% […]
Intrathoracic Side-Overlap Technique Improves Recovery in Esophagectomy
Side-overlap esophagogastrostomy offers significant benefits over circular stapled techniques for Siewert type I/II adenocarcinoma. Postoperative pain scores on day 1 and 2 were significantly lower in the side-overlap group (3.49 vs. 4.04 and 2.73 vs. 3.06, respectively). Severe gastroesophageal reflux occurred in just 14.5% of the side-overlap group versus 34.0% with circular stapling. Dysphagia symptoms […]
Effective Therapies Cut Esophageal Stricture After ESD
Oral hydrocortisone sodium succinate with aluminum phosphate gel significantly reduces postoperative esophageal stricture after endoscopic submucosal dissection (ESD). This combination therapy lowers stricture risk by 92.5% compared to standard care (relative risk = 0.075). Using polyglycolic acid sheets with fibrin glue minimizes the need for endoscopic balloon dilatation, reducing sessions by an average of 6.4. […]
Gastric partitioning cuts complications in gastric outlet obstruction
Stomach-partitioning gastrojejunostomy (SPGJ) outperforms conventional gastrojejunostomy (CGJ) in managing gastric outlet obstruction (GOO). SPGJ reduces delayed gastric emptying by 76% (relative risk = 0.24). Major postoperative complications drop by 74% (relative risk = 0.26). SPGJ offers a strong alternative to CGJ with similar survival rates and length of stay. No significant difference in reintervention rates […]
New Nomogram Predicts Spontaneous Closure in Duodenal Fistulas
A newly developed nomogram predicts spontaneous closure in septic patients with external duodenal fistulas post-infection control, critical for surgery decisions. Spontaneous closure rates after infection control were 53.2% in the development cohort and 57% in validation. Six key factors were identified: time to infection control, infection extent, emergency surgery, fistula size, duodenal decompression, and albumin […]
Endoscopic Dissection Transforms Early Upper GI Carcinoma Care
Endoscopic Submucosal Dissection (ESD) provides an advanced local treatment option for early upper gastrointestinal carcinomas, enabling complete tumor removal and improved patient outcomes. ESD allows for en bloc resection of early GI neoplasia, aiding in precise pathology and risk assessment. Key candidates for ESD include high-grade intraepithelial neoplasia and superficial early carcinomas without visible deep […]